Patient Forms

For your convenience, North Central Surgical Center makes it easy to download and print several of our required patient forms before your procedure or exam. After printing and completing the forms, please bring them with you on the day of your procedure, or you can fax forms to 214.265.2820. Our business office is available to answer any questions you have. Please call 214.853.5259.

Admissions Packet – Hospital/Pre-Admissions Testing/Hospital Outpatient Surgery Center

• Registration paperwork (pdf)

Admissions Packet – CT Injections/Myelogram/Ultrasound/XRay Exam

• CT Injections/Ultrasound/XRay Exams (pdf)
• Myelogram (pdf)

Admissions Packet – MRI and Arthrograms

• MRI/Arthrograms (pdf)

Admissions Packet – Bone Density

• Bone Density (pdf)

En Espanol:

• Spanish – North Central FRN (pdf)
• Spanish Translation FAQ
• Spanish – Consent for Medical Treatment (pdf)

General:

• Advanced Directives (pdf)
• Medication Reconciliation (pdf)

Privacy & Patient Rights:

• North Central Language Translation
• Notice Privacy Practices – English
• Notice Privacy Practices – Spanish
• Patient Rights and Responsibilities
• Social Media Terms