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Advanced Specialty Care

Registration Forms


Bariatrics Care Breast Surgery Colon & Rectal Care Endocrinology Diabetes Treatment Endoscopy Services Heartburn Healers Vein Treatment
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Nobody likes to spend hours at the doctor's office.  To ensure that our patients' visits are as expeditious as possible, we have provided materials here to help them to be prepared, informed and ready to talk with their doctor and families about their health.  Below are documents to aid in that endeavor, but keep in mind that these forms are most applicable to patients that have never been seen in our clinics.  Please print out the appropriate forms, and fill in all pertinent fields.  At this time online registration is not available, so you will need to have a printer hooked up to your computer to utilize this feature.

For all appointments, please review our Privacy Policy.  The Ackowledgement of Notice form needs to be signed, acknowledging that you have reviewed and agree to this policy.

For appointments with Dr. Koning, Dr. Archer, Dr. Buzzas, Dr. Maddox, Dr. McCarthy, or any of the physician's assistants, please print and fill out the following forms:

Registration Form
Financial Agreement
Acknowledgement of Notice (please review our Privacy Policy)
General Health History

For appointments with Dr. Jaderborg, please print and fill out the following forms:

Registration Form
Financial Agreement
Acknowledgement of Notice (please review our Privacy Policy)
General Health History
Medication Sheet

For appointments with Dr. Monchamp, please print and fill out the following forms:

Registration Form
Financial Agreement
Acknowledgement of Notice (please review our Privacy Policy)
General Health History

  To download, view, and print these documents, your computer must have Adobe Acrobat Reader® installed.  Don't have Adobe Acrobat Reader? Go to Acrobat Reader to download and install the latest version.  Once installed, the forms should load upon clicking the links above.

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