Patient Forms

Thank you for taking the time downloading our forms. Just click on the appropriate form and print. If possible, please drop these forms by our office prior to your visit. If your appointment is several days, in advance you may mail the forms to our office (see mailing address below). Otherwise, you should arrive 30 minutes prior to your scheduled appointment.

Mailing Address:

Fayetteville location:
Village Surgical Associates, PA
1841 Quiet Cove
Fayetteville, NC 28304
Fax Number: 910-323-3862

Erwin/Dunn location:
Village Surgical Associates, PA
133 Professional Park
Erwin, NC 28339
Fax Number: 910-892-1992

 

Click on the document titles below to view and print the forms.

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The following forms are in PDF format. In order to view and print these forms, you will need the free Adobe Reader software. If you do not have Adobe Reader, you can Download it Here.

General Patient Information Form (all patients)

Morbid Obesity Form

Notice of Privacy Practices