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General Forms


 

HIPAA Authorization to Release Records:
 HIPAA Authorization for the Disclosure of Protected Health Information.

HIPAA Authorization to Disclose Information: 
HIPAA Authorization of Use and Disclosure of Protected Health Information.


 

Policies and Notices


 

Notice of Privacy Practices: 
(Memorial and Katy Surgical Specialists Notice of Privacy Practices.)

Financial Policy: 

​(Financial policy for Memorial and Katy Surgical Specialists.)


 

New Patients


new_patient_registration_packet:

 

     
    About Us

    Discover how we accommodate patients with surgical expertise and individually focused care.
    Learn More >>

     

       
    Meet Our Doctors

    Learn more about the Board Certified surgeons of Memorial and Katy Surgical Specialists.
    Learn More >>

     

     
    Download Forms

    Patient forms are available for you to download and fill out before you come in for an appointment.
    Learn More >>

     


    1140 Business Center Dr. Suite 400 Houston, TX 77043
    18400 Katy Freeway Suite 420 Houston, TX 77094

    Copyright © 2010 Memorial and Katy Surgical Specialists. All Rights Reserved.