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Documents

In an effort to speed your check in process, please print the necessary forms and submit to your physician’s office on the day of your appointment.

Assignment of Benefits and Billing Rights

Disability Information

HC Consent for Release of Information 2023

MRI Screening Questionnaire & Consent

Notice of Privacy Practices

Pregnancy Disability Information

Risk Assessment for Lynch Syndrome and Hereditary Breast and Ovarian Cancer Syndrome

New Patient Forms

Allergy Patient History Form

Bariatric New Patient Questionnaire

ENT Patient History Form

General & Vascular Surgery Patient History Form

Internal Medicine Patient History Form

New Patient Registration Form (All Specialties)

OBGYN Patient History Form

Ophthalmology Patient History Form

Orthopaedics Patient History Form

Rheumatology Patient History Form

Also of Interest:
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  • Medical Patient Portal

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Main Campus

1455 East Bert Kouns
Shreveport, LA 71105
Main 318-798-4500
Physician Referral 318-798-4643

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