Pre-Registration Forms

We want to make the most of your time with the physician. In order to keep appointments on time, we ask that patients print out the following forms and complete them prior to arriving at your appointment if possible.

Pre-Registration Forms

Download Forms

Forms included in the registration packet are:

  1. Treatment Authorization and Privacy Acknowledgement
  2. Registration Form
  3. Emergency Information
  4. Release of Information Form
  5. List of Medications
  6. Pain History
  7. Current List of Insurance Contracts for Salina Regional Neurosurgery
  8. Medicare Secondary Payer Questionnaire

Other Forms

Physician Forms

If you have questions about the Pre-Registration forms and need additional assistance our office is open Monday through Friday, 8 a.m. to 5 p.m., and closed from noon to 1:30 p.m. during the lunch hour. For after hour emergencies, please call (785) 452-4013.