HERNIA INSTITUTE OF PENNSYLVANIA
North Penn Hernia Institute
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PATIENT REGISTRATION and INFORMATION FORMS


Please "PRINT" Each of the Forms Below


PATIENT REGISTRATION FORMS (Print Out, Complete and Mail or Fax to us prior to surgery)
Click each line to view forms for printing
PRINT, COMPLETE, SIGN and DATE then MAIL (or FAX) the ABOVE FORMS 1 thru 5 To:

MAIL FORMS TO:
NORTH PENN HERNIA INSTITUTE
MEDICAL OFFICE BUILDING at LANSDALE HOSPITAL
125 MEDICAL CAMPUS DR, SUITE 310
LANSDALE, PA 19446
ATTN: Hernia Surgery Coordinator
-OR- FAX FORMS
TO:
215-368-3569

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ADDITIONAL PATIENT INFORMATION FORMS

THESE NEED NOT BE RETURNED. PRINT and RETAIN for your Records and Personal Information

IMPORTANT!!!

Please call the Day Surgery Unit (*number below) one day prior to your surgery between 2:30 PM and 4:30 PM to confirm your appointment time (time required for your arrival at registration). This is generally 1 1/2 to 2 hours before your scheduled surgery time. If you are having your initial surgeon visit and consultation on the same day as your surgery, we ask you to arrive at least 2 hours before your surgery time to allow you to meet your surgeon and have any questions you may have fully answered and explained. We will discuss any special needs, review your prep and answer any questions you may have regarding your surgery.

If your surgery is scheduled for a Monday, please call on the prior Friday (3 days before surgery). If the day before your surgery is a Holiday, call this number 2 days in advance.

The Day Surgery Unit is open from 6:00 AM to 7:30 PM Monday through Friday

*CALL 215-361-4520 / or 4521

PLEASE AGAIN NOTE-If you are going to have your initial consultation and examination with your surgeon on the same day as your surgery, please be prepared to arrive at the "Same Day Surgery Center" of Abington Health, Lansdale Hospital not less than 2 hours before your scheduled surgery time to effectively complete this preliminary evaluation and discussion. Failure to arrive on time, unless otherwise specified, may result in surgery delay or postponement to a later date.

PRIVACY POLICY

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