As we all know, sometimes doctor visits require necessary paperwork. To make it more convenient for you, you may download our required forms, print them, and fill them out prior to your appointment. Capital Region Orthopaedics complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Capital Region Ambulatory Surgery Center, LLC, complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex

Along with your completed paperwork, please bring the following with you to your scheduled appointment:

  • Insurance card
  • Photo ID
  • Referrals (if required)
  • Co-payments

For MRI scans, wear loose-fitting clothing (no metals).

New Patient Forms

Medical History Form (PDF) Patient Check-In Form (PDF)

Ambulatory Surgery Center Forms

Pre-Admission Testing Prior to Surgery FormHealth Care Proxy (PDF)Patient Satisfaction Survey (PDF)

After your surgery, please complete the Patient Satisfaction Survey and send to: 

Capital Region Ambulatory Surgery Center
1367 Washington Avenue, Suite 401 
Albany, NY 12206

The latest version of Adobe Acrobat Reader is required to view and print PDF files, and it is available here 

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