Patient Document Page

Advanced Directive Questionnaire
An Advanced Healthcare Directive, also known as a Living Will, is a legal document in which a patient specifies what actions should be taken for their health is they are no longer able to make decisions for themselves. If requested, we can provide a blank document for your review. We are unable to be a witness for this document.

ASPC Advance Directive
 

Patient Bill of Rights
The Patient Bill of Rights lists information that we are required to provide to a patient each time that they have an appointment at this Facility.

ASPC Bill of Rights
 

Outpatient Procedure Consent
All patients must sign a consent that explains what procedure will be completed. This document will have the type of procedure, the location of the injection and general information regarding your procedure.

Outpatient Procedure Consent (McCurdy)
Outpatient Procedure Consent (Megdal)
Outpatient Procedure Consent (Thomas)
 

Post Procedure Discharge Instructions
Once your procedure has been completed you will be given instructions on what you can expect for the following few days. Please read these carefully and if there are any questions at all, please contact our office immediately.

Post Procedure Discharge Instructions
 

Pregnancy Test Waiver
All females under the age of 50 are required to take a pregnancy test. If requested, this form can be signed instead of taking the pregnancy test.

ASPC Pregnancy Test Waiver
 

Financial Assistance Application
Our Medical Financial Assistance program allows us to provide assistance to eligible patients unable to pay for their medical care. Eligible patients can receive free or reduced cost services based on their income level as compared to the Federal Poverty Guidelines. To be considered for this program this form MUST be completed in its entirety. Submission of the application does not guarantee any assistance will be provided.

Financial Assistance Application 081518