SWAT Surgical Associates L.L.P.

Patient Forms

At SWAT Surgical Associates, we try to make every aspect of your visit easier and more convenient. For this reason, our patient forms are available for download on our website. Please see the links below:

Links/Downloads:

• SWAT Surgical Forms:
  • Notice of Privacy Practices (HIPPA)
  • Avisode Atencion Privada (HIPPA)
  • New Patient Information Form
  • Patient Registration
  • Consent to Treatment
  • Consent for Use and Disclosure of Protected Health Information
  • Authorization for Release/Transfer of Medical Records
  • Patient Financial Responsibility Form
  • Medicare
  • Long Term Medication Summary
  • Nursing Assessment

• Lap-Banding Forms:
  • Lap-Banding - Welcome Letter
  • Lap-Banding - Notice of Exclusions
  • Lap-Banding - Questionnaire

• All Forms:
  • PRINT ALL FORMS

  To submit form(s):

  Print, fill in the necessary information and do one of the following:

  Fax
  806.788.8500

  Mail
  SWAT Surgical Associates., L.L.P.
  3509 22nd Street
  Lubbock, Texas  79410

  Bring Form(s)

  Schedule appointment and bring form(s) with patient