Colorectal Surgical Associates Kansas City Forms

Patient Information and Privacy

• New Patient Paperwork
• Notice of Privacy Practice HIPAA
• Good Faith Estimate Form
• Release of Records
• Request for Records
• New Patient Appointment Policy for Cancellations, No Shows and Reschedules
• CSA Appointment Cancellation Policy

Office Preparation Instructions

• CSA Office Prep

Colonoscopy and Surgical Preparation and Post Operative Instructions

*These preps will not be used for any visit to our offices*

• NICHOLS Prep & Post Abdominal Op
• Anorectal Orders
• Colonoscopy Prep for Patients with Renal Issues ONLY
• Colonoscopy Prep Instructions

Incontinence and Constipation Testing and Therapy Instructions

• PFT Bowel Diary
• Sitz Marker Instructions
• PFT Home Exercises Incontinence
• PFT Home Exercises Constipation