Latex Allergy Assessment Form

Medication Reconciliation Form

Perioperative Flow Sheet

Pre-Operative Instructions

Patient History

Patient Satisfaction Survey

Consent for Surgical Treatment Form (Sample)

Consent for Gastrointestinal Endoscopy Form (Sample)

**The above documents can be downloaded by clicking on the link, and choosing to save or open the document. If you are asked to complete and submit any of these documents, you may do so by filling them out online and emailing them to lpn@winterhavenasc.com.  Or, you can print them out, complete them manually and fax them to (863) 618-1101.

325 Avenue B, NW, Winter Haven, FL 33881 Phone: 863.291.4000 Fax: 863.299.9179
© Winter Haven Ambulatory Surgical Center, LLC 2003
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