Patient Forms
Download, review, and print.
Save time at your appointment by reviewing and completing these forms in advance. Click any form below to download the PDF directly.
Consent & Disclosure
Required consent and disclosure forms. Please review before your appointment.
Network Disclosure for Surgical First Assist
Disclosure regarding network status of surgical first assistants who may participate in your procedure.
Consent for Payment
Authorization for billing and payment processing related to your surgical care.
Informed Consent for Telemedicine Communication / Appointments
Consent for virtual consultations and telemedicine-based communication with Dr. Bayouth's office.
HIPAA Release of Patient Information
Authorization to release your protected health information in compliance with HIPAA regulations.
Pre-Operative Instructions
Preparation guidelines to review before your scheduled procedure.
Post-Operative Instructions
Diet and recovery guidelines following your procedure. Your surgeon will review these with you.
LINX Surgery — Post-Op Diet & Restrictions
Dietary guidelines and activity restrictions following LINX magnetic sphincter augmentation surgery.
Hiatal Hernia & Fundoplication — Post-Op Diet & Restrictions
Dietary progression and recovery instructions following hiatal hernia repair or fundoplication (Nissen/Toupet).
Questions
Need help with a form?
If you have questions about any form or need assistance completing paperwork before your visit, call our office and we will be happy to help.