(760) 724-5352 Home Our Doctors Medical Services Medical Forms Contact Us Medical Forms Here at Coastal Surgeons we want your experience with us to be as pleasant as possible. Having your paperwork prepared before you arrive will help speed up your check in process. New Patient Information and Financial Policy Instructions: Please fill out new patient information completely. Also, read and sign the financial policy portion. Bring form along with your insurance card to your first visit. Patient Registration Click Here Health Insurance Portability and Accountability Act Instructions: Please read and sign Notice of Privacy Practices. Bring signed form with you to your first visit. HIPAA Notification Click Here Health History Questionnaires Instructions: Please fill out as completely as possible. Bring form with you to your first visit. Health History Questionnaire Click Here Dr. Toosie Health History Questionnaire Click Here Breast Questionnaire Instructions: Please fill out the top portion of the form prior to your visit. Bring form with you to your visit. Breast Referral Questionnaire Click Here List of Insurance Plans Accepted by Coastal Surgeons Coastal Surgeons accepts most government and commercial health insurance plans. In all cases verify with your insurance company that Coastal Surgeons is a contracted provider. We also accept cash paying patients. Patient Financial Agreement Form Instructions: Please read and sign all sections of this form. Bring it with you on the day of your appointment. Patient Financial Agreement Form Click Here Medication List nstructions: Please read and sign all sections of this form. Bring it with you on the day of your appointment. Medication List Form Click Here LOCAL HOSPITALS Tri City Medical Center Scripps Memorial Hospital (Encinitas) Palomar Medical Center & Pomerado Hospital LOCAL SURGICAL CENTERS North Coast Surgical Center Center for Surgery Carlsbad Surgery Center CONTACT US Oceanside: 3601 Vista Way, Suite #203 Encinitas: 351 Santa Fe Drive, Suite #250 Phone: 760-724-5352 Fax: 760-724-5447 Coastal Surgeons Copyright © 2021 All Rights Reserved | Site by DYNAMICIO

(760) 724-5352 Home Our Doctors Medical Services Medical Forms Contact Us Home/Ken Grill About Ken Grill This author has not yet filled in any details. So far Ken Grill has created 0 blog entries. LOCAL HOSPITALS Tri City Medical Center Scripps Memorial Hospital (Encinitas) Palomar Medical Center & Pomerado Hospital LOCAL SURGICAL CENTERS North Coast Surgical Center Center for Surgery Carlsbad Surgery Center CONTACT US Oceanside: 3601 Vista Way, Suite #203 Encinitas: 351 Santa Fe Drive, Suite #250 Phone: 760-724-5352 Fax: 760-724-5447 Coastal Surgeons Copyright © 2021 All Rights Reserved | Site by DYNAMICIO