MemorialCare Heart & Vascular Institute

at Long Beach Memorial Medical Center

Patient Forms

You will be asked to complete a number of forms prior to your admittance to the hospital and your surgical procedure. It is important that you complete each form to the best of your knowledge. Your treatment will be based on the information you provide. Even though it may seem you are being asked an endless number of questions, the information you provide your doctor and hospital is necessary. Your procedure may require the following forms:

Pre-Admittance Forms

• Adult Patient Profile
• Adult Inpatient Profile

Operating Room Form

• Anesthesia Consent

Specific Surgical Form

• Surgical Consent

Forms require Adobe Acrobat Reader to view.Depending on the type of surgical procedure, or if the patient is a minor, additional forms may be required.