Patient Forms & Policies
Thank you for selecting Animas Surgical Hospital in Durango, Colorado for your surgical procedure. After your procedure has been scheduled, you may download, print, and complete the forms below prior to your visit to help speed up the registration process. Please right-click and select "Save As" on the link. You must save the document to your device before completing the form.
Established patients can update forms online through our patient portal. If you need help accessing the portal, please call us and we’ll be happy to help.
Please be sure to check the pre-op instructions in advance of your surgery.
Downloadable Forms:
- Conditions of Admission
- Patient Information Form
- Medical Records Release Form
- Surgical Intake Form
- Pre-Op Instructions
- Notice of Nondiscrimination
- Notice of Privacy Practices
- Notice: Your Rights and Protections Against Surprise Medical Billing
- Interpretation Services
- Patient's Rights and Responsibilities
- Advanced Directive Information Sheet
- Notice of Patient's Right to Complain or File a Grievance
- Right to Receive a Good Faith Estimate of Expected Charges Notice
Please note: It may take a few minutes to load the forms if you are using a slow internet connection. If you are unable to view the forms, you may need to download Adobe Acrobat for free by clicking on the icon below.
Under the final rule, "Nondiscrimination in Health Programs and Activities", contained in Section 1557 of the Affordable Care Act, issued by the U.S. Department of Health and Human Services, Animas Surgical Hospital makes provisions to ensure individuals are able to receive services and benefits under any of its programs and activities free from discrimination. Individuals are protected from discrimination under local, state, or federal law. Animas Surgical Hospital cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo.
ATTENTION: If you do not speak English, language assistance services, free of charge, are available to you. Please call 1-844-2032025 (TTY: 1-877-486-2048).
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-844-203-2025 (TTY: 1-877-486-2048).
CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-844-203-2025 (TTY: 1-877-486-2048).