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There are a few things that you can do in order to make your pre-operation office visit go smoothly. Please be aware that no surgery is performed at the initial consultation visit, but the child must be physically present.

Please note that failure to have appropriate authorization will result in either rescheduling the appointment or treating patient as a self-pay, and payment must be made at time of service.

Also note that failure to have relevant medical records and x-rays may result in rescheduling of the appointment.

Forms

Please complete these forms and bring them with you to your first appointment. If you received forms before your visit, please bring those completed forms with you to the appointment as wellll.

 Name  Description Download   
Patient Registration Form Basic patient information needed to add patients into the system. (English) (en Espanol
Patient History A description of the medical history of the patient.  (English) (en Espanol
Ambulatory Care Consent Form Granting permission to provide routine diagnostic procedures and treatment. (English) (en Espanol

Additionally, you may be asked to complete these forms:

 Name  Description Download   
Consent to Operation A form that gives the surgeons permission to treat the patient.  (English) (en Espanol
Authorization to Release information for Continuity of Care This form permits our office to share the patient's information with other healthcare providers.  (English) (en Espanol)

 

Billing Policy

Appointments and More Information

For more information, visit Pediatric General Surgery. To make an appointment or to ask questions, please call (727) -767-4170.


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All Children's Hospital
501 6th Ave South
St. Petersburg, FL 33701
(727) 898-7451
(800) 456-4543

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