Dear Patient,
Thank you for your interest in Sacramento Advanced Laparoscopic Surgery Associates (SALSA). .
If you are a patient requiring or being referred for a laparoscopic surgical procedure other than obesity surgery, please complete the following forms and bring them to the office at your initial visit.
- PATIENT REGISTRATION FORMS
- Please read the Patient Policies that are included in the PATIENT REGISTRATION FORMS that you have already downloaded from the above link and printed.
- WE ALSO NEED A COPY OF YOUR HEALTH INSURANCE CARD (front and back)
- INSURANCE AUTHORIZATION FOR HMO PATIENTS -If you are an HMO patient, we will need to receive a copy of the AUTHORIZATION for your consultation.
- Our office staff will help in obtaining authorization but we must receive a referral form from your primary care provider (either FAX or mail).
- Please call our office at (916) 797-7555 so we can send you a) a consent form and b) a laparoscopic surgery evaluation both pertaining to your specific condition.
In order to facilitate your paperwork processing, please send your registration forms and copy of your health insurance card via fax or mail to our address:
Sacramento Advanced Laparoscopic Surgery Associates (SALSA)
Donald J Waldrep, MD, FACS, FASMBS
Two Medical Plaza
Suite 264
Roseville, CA
95661
Phone: (916) 797-7555
Fax: (916) 797 7501
Donald J Waldrep, MD, FACS, FASMBS
Two Medical Plaza
Suite 264
Roseville, CA
95661
Phone: (916) 797-7555
Fax: (916) 797 7501