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Patient Forms Area
UPDATED NOV 2013
PLEASE DO NOT SEND ANY FORMS OR RECORDS UNLESS YOU HAVE REGISTERED HERE FIRST:
Please click the link below to print, complete and mail your packet to us for your free review. Note the link above to register first; records sent to us without a registration form on file risk being destroyed, as we cannot track unregistered cases. Thank you for understanding. If you have an in-office appointment, please print, complete and bring these forms with your records to your appointment. Thank you.
We love to hear from our patients and greatly value your feedback! The following forms are included in our post-op packages; however, if you need an additional copy of either, please feel free to download them from here. Once you have completed the form(s), please return them to the CEC offices. All correspondence is confidential and is never shared outside the CEC for any reason. If you have any questions, please contact us.
Please give us your impressions of how we did! Your responses are intended to enable us to better serve our patients.
The Center for Endometriosis Care has the largest, ongoing study evaluating the long-term results of excision of all Endometriosis. Your input allows us to accurately calculate our pain relief success, recurrence rates, and fertility rates over a long period of time. Without you, our accuracy decreases and our intervals of follow-up are shortened. Please help us maintain our excision study by taking a moment to fill in these details. For your convenience, you may either print the questionnaire above or save a stamp and complete the form now - simply do so online via our private, interactive form located at: http://www.centerforendo.com/followupquestionnaire.htm
Are you a former or existing CEC patient who needs to request another copy of your records from us? Click here to print and send us the form.
A Records Release FROM your Physicians TO the CEC?
Are you considering sending us a copy of your medical records for our free case review and evaluation? More often than not, you will be required to complete your own physician’s records release form. However, in some instances, other professionals may require a notice of release from our Center. In those isolated cases, click here and provide your doctor(s) with this form. Note that separate submission of your files and forms requires advance notice to the CEC so we can be aware. All packages will be held until completed before being submitted for review.
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