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Patient Forms

Welcome to our Patient Forms area. We will be adding downloadable CEC Forms to this page over time for the convenience of our patients. Please note that the free Adobe Acrobat Reader is required to access and print our Forms. If you do not have the latest version, it is available for free via a short download by clicking the logo:

Existing Patients:

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

Patient Evaluation Form

Please give us your impressions of how we did! Your responses are intended to enable us to better serve our patients.

Follow-up Questionnaire

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.

New & Prospective Patients:

SAVE TIME BY PRINTING, COMPLETING AND BRINGING YOUR FORMS TO OUR OFFICES AT THE TIME OF YOUR APPOINTMENT. NOTE THAT NOT ALL FORMS WILL APPLY TO YOUR SPECIFIC CASE; DOWNLOAD THEM ACCORDINGLY.

Pre-Surgical Questionnaire for Operative Patients

Please print, complete, and bring this Pre-surgical Questionnaire sheet to your pre-op appointment by clicking here to access the file.

New Patients (In-office consult and surgical cases alike)
Do you need help pinpointing your bowel and/or bladder symptoms? Please print, complete and bring either or both of the following information sheets to your appointment or include when submitting your file via mail. Please access these files accordingly:

Patient Bladder Symptom Questionnaire

Patient Bowel Symptom Questionnaire

Please print, complete and bring our Patient Information Sheet to your appointment (all patients). Please click here to access this file.

Click here to read and sign a copy of our pain management policy that our patients are required to file with our office. Note that these are general guidelines and may be altered on a case by case basis.

All Patients:

Please click here to access our “Notice of Privacy Practices for Robert B. Albee, MD & Associates, LLC.” document. This text version of our Privacy Practices Brochure is available online for all patients to access, read and sign. Please be advised this important document describes how information about our patients may be used and/or disclosed, and how patients can access their information. Please review this material carefully and return your signed copy at the time of your office visit.

Records Release from the CEC
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.

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, feel free to click here and provide your doctor(s) with this form.