New patient forms
Please complete the following forms, and mail them to our office, or bring them with you to your appointment.
Complete the Patient Information Form to provide your demographic and insurance information to Surgical Institute of South Dakota, PC.
Complete the Patient Health History Form to provide your health history to Surgical Institute of South Dakota, PC.
Complete and sign the Privacy Notice Acknowledgement to affirm that you have received a copy of our Privacy Notice and to authorize us to speak to family or friends on your behalf.
Weight loss patient forms
Weight loss patients must complete an online Patient Information Form after attending a seminar. The form must be completed at least 1 week prior to your consultation with the doctor. Please contact our office if you need help accessing or completing your Patient Information Form.
Medical record release authorization forms
If you'd like a copy of your medical records sent to another facility, please complete and return a signed authorization form to our office:
Attention: Medical Records
911 East 20th Street
Suite 700
Sioux Falls, SD 57105
Our fax number:
Use the Release of Records TO Surgical Instituteform to authorize your physician to release your medical records to Surgical Institute of South Dakota, PC.
Use the Release of Records FROM Surgical Institute form to authorize Surgical Institute of South Dakota, PC to release your medical records to another physician, or for any other purpose.
