Forms and Instructions for Patients

The Division of Thoracic and Foregut Surgery performs exams and procedures on the second floor of the Ambulatory Care Center next to Strong Memorial Hospital. Arrangements also can be made to see your surgeon at Park Ridge Hospital or at Clifton Springs Hospital. Talk with your surgeon for more information.

At the time of your appointment, please bring with you the following items:

• System Review Form, completed in full
• Physician Contact Letter, completed in full
• A Prior Authorization Form, if referred by an HMO physician
• Medical records
• X-rays and/or CT scans
• Insurance card(s)

If you do not have an authorization form from your HMO physician at the time of your visit, you will be responsible for payment at the time of your appointment.

If you do not have any type of insurance coverage, you will be responsible for payment at the time of your appointment. We accept cash or check.

It is important that you are on time for your appointment. If you are unable to keep this appointment, please notify the office as soon as possible.