Dear Patient,

Thank you for your interest in Southern California Advanced Laparo-Endoscopic Surgery (SCALES).

If you are a patient requiring or being referred for a laparoscopic surgical procedure other than obesity surgery, please complete the following forms and bring them to the office at your initial visit.

1. PATIENT REGISTRATION FORMS

• Please read the Patient Policies that are included in the PATIENT REGISTRATION FORMS that you have already downloaded from the above link and printed.

2. WE ALSO NEED A COPY OF YOUR HEALTH INSURANCE CARD (front and back)

3. Please call our office at (805) 230–0030 so we can send you a) a consent form and b) a laparoscopic surgery evaluation both pertaining to your specific condition.

In order to facilitate your paperwork processing, please send your registration forms and copy of your health insurance card via fax or mail to our address : Southern California Advanced Laparo-Endoscopic Surgery ( SCALES ) Donald J. Waldrep, MD, FACS, FASMBS 415 E. Rolling Oaks Dr. Suite 240 Thousand Oaks, CA 91361 Fax: (805) 230 2995

 

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