PDF Documents and Forms

If you fill a form out by hand, please use black ink. Otherwise, the forms will not scan properly and you will have to fill them out again.

The following PDF forms and documents are available:

• Medicare ABN Form
• HIPAA - Notice of Privacy Practices
• Notice of Your Rights and Protections Against Surprise Medical Bills
• Document Charges
• Low Fiber Diet
• Preparation for Occult Blood Test
• Post-Operative Care Instructions
• Home Care Instructions: Rubber Band Ligation
• Home Care Instructions: Thrombosed External Hemorrhoid
• Your Medical Record Rights in Texas
• Medical Records Release Form
• Anesthesia: What You Should Know and Expect
• THPG Authorization Release Forms (for former Dr. Staniunas patients)
  • Blank Form
  • Pre-Filled with our Address

If you cannot read the forms, you can get a PDF reader from Adobe for free: https://get.adobe.com/reader.