Download Useful Forms

 ​​​​​​​​Dear Patient,
The following forms were placed here for your convenience. Whether you are getting ready for your first appointment with us, you are preparing a follow-up appointment or you are interested in one of the diagnoses, tests or treatments offered by our office, Dale Medical Center or the affiliated Clinics, you should find forms and information posted here. For general information about procedures or operations, please use the "Procedures" tab at the top of this page.

These documents are placed here only so that you can print the information, fill it up if needed and bring it with you at the time of the appointment or send it to us as instructed.

Please do your best to complete the forms - some of the information may be instrumental in qualifying you (or not) for one of the surgical programs offered at Dale Medical Center.​

Click on a file to download.

Please use additional papers as needed; you can provide your own list of medications and medical problems.  

NOTE: in order to access your portal you need a username and password, provided by the office.