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Patient Form Center
Are you or your child scheduled for a surgical procedure? You can find and download all instructions and forms here:
• Medication Reconciliation Record Click here for a medication history form to complete before surgery.
• Latex Allergy Form Click here for a latex allergy form to complete before surgery.
• Pre-Surgical Testing Form Click here for a medical and anesthesia history form to complete before surgery.
• Pre-surgery Checklist Click here for a convenient, pre-surgery checklist to complete before surgery.
• Outpatient Surgery Tips for Adults Click here for information on pre-surgery preparations, contact information, and location of your surgery.
• Outpatient Surgery Tips for Children Click here for information on pre-surgery preparations, contact information, and location of your child’s surgery.
Forms are posted online in PDF format and will launch in Adobe Acrobat Reader. There are two choices when filling out:
1) Use the interactive fields to fill in your information, save the form with your name and date (yourname_052312_PreSurgery), attach and email the form to firstname.lastname@example.org
2) Print out the form, fill in your information and either fax or mail to our office.
Hudson Valley Ambulatory Surgery
75 Crystal Run Road, Building B, Suite 225, Middletown, NY 10941
T: (845) 692-9900 F: (845) 692-0800