If you have setup an appointment with GEC SW (click here for contact information), please take the time to fill out the following patient information forms before your first visit.

Instructions:
-For each step, choose the appropriate blue link. For step 3, be sure to select both links that correspond to your physician. (Note: If you do not have Adobe Acrobat Reader, you will need it and may download it for free here or by selecting the icon on the right).
-After selecting the link, a new window will pop up. From this window, choose the print icon at the top of your browser window. (All of these forms are in the PDF format).

-After all forms (patient registration, patient survey, and physician-specific history and release forms) have been printed, simply fill them out with a pen and bring them with you on your appointment date.


All new patients, please read our Patient Information Letter for general office policies and guidelines.

Patient Information Letter for GEC
Patient Information Letter for Lanza
Patient Privacy Form


1. Patient Registration

English (42k)    Spanish (35k)


2. Patient Survey

English (22k)

3. Physician Specific Forms

Frank L. Lanza, M.D., P.A., F.A.C.P., F.A.C.G.
New Patient History
 Medical Release Form (25k)

Robert E. Davis, M.D., P.A., F.A.C.P., F.A.C.G.

J. Guillermo Trabanino, M.D., P.A., F.A.C.G.

Keith H. Fiman, M.D., P.A., F.A.C.G.

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