Download Procedure Forms

Thank you for giving us the opportunity to care for your patient. Below, you will find the necessary forms for procedures performed at our hospital. These forms are in PDF format. If you do not have Adobe®Reader® on your computer, you can download it for free by going to Get Adobe Reader.com. If you have any questions, please feel free to contact Jaclyn.McDaniel@thcds.com.

Surgery Scheduling Form

Anesthesia Consent

Anesthesia Consent Spanish

CPAP Equipment Checklist

This form collects important information about CPAP machine/equipment requirements.

Disclosure and Consent

Disclosure and Consent Spanish

H&P Interactive Form

This form collects history and physical information for short stay patients.

Hysterectomy Consent

Pain Care Procedures

Pre-Assessment Services Instructions

Instructions on scheduling appointments with pre-assessment testing.

Pre-Testing Info Sheet

This form allows the patient to acknowledge pre-testing and scheduling information.

Pre-Op Testing & Day of Surgery Orders

Post-Op Physicians Orders

This form details physician orders for post-op outpatient care.

Sleep Apnea Form

This form provides the “STOP-BANG” patient survey and scoring model.

Perioperative Services SURGICAL and AESTHETIC MEDICINE Medical Photography Authorization Form

This form should be used if the surgeon plans to take any photographs before, during or after the procedure. This includes use on social media accounts.

Anesthesia and/or Perioperative Pain Management - Spanish

Diagnostic Imaging Order Form

This form can be used to order imaging services.