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REGISTRATION


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REGISTRATION


SCROLL BELOW THE REGISTRATION FORM TO ACCESS ANY PATIENT FORMS YOU MAY NEED.

PLEASE READ THE FOLLOWING CAREFULLY BEFORE PROCEEDING:

For the past 30 years, the CEC has been very pleased to evaluate cases from around the world, at no cost to the patient, in an effort to help the international endometriosis community connect with better care. Given the vast time and effort our surgeons dedicate to the review and procedural planning process with each patient who sends their case, however, we ask that only those individuals who are committed to potentially pursuing treatment here at our Center in the near future send their files for review. We appreciate your understanding.

We do not accept record packages for review by email; please refrain from emailing any case documents to the CEC staff or our surgeons. Please follow the instructions you will receive after registering to ensure a timely review of your case file.

Please be sure to read our guidelines regarding high BMI and other surgical risk factors which may influence our ability to consider your surgical candidacy before registering. If you do not know your BMI, you can calculate it online for free here. We also encourage our visitors to read our FAQs as well.

The registration form below is for new records review cases only. If you have registered previously but did not send your case and would like to do so now, please first check to see if we have your prior registration on file before registering again. Please do not register if you are an existing CEC patient (current or any year prior) or have (or plan to schedule) an in-office appointment. If you are an existing CEC patient (from any year) in need of assistance, please call us at 770-913-0001 and we'll be delighted to help you. If you were looking to book an in-office appointment (consult costs will apply), please note appointments are not made online and you should not register for the records review; instead, please call us at 770-913-0001 and our staff will be delighted to book you and review the dates available/costs of your visit/insurance aspects with you. Thank you.

How the registration process works: every registration is responded to by email (or postal mail if email - the preferred method - is not available) with an information packet containing next steps, instructions, and all the necessary details and requirements for the free records review. The email packet is usually sent within 24-48 hours after you've registered unless temporary delays are specifically noted. If you do not receive your e-packet, please check your spam file. If you receive an email from one of our surgeons but not your packet of instructions, that means the mail went to your blocked/spam file or was otherwise not delivered by your email provider. Please check and notify us accordingly if you still did not receive it by sending a message to Heather@CenterForEndo.com.

GDPR/Privacy: we take your privacy very seriously. By proceeding with the following registration data input, we will collect personal information about you, including but not limited to your name, address, email and phone number. We will use your data only to personalize your correspondence with us, administer your case, and provide any products and/or materials and/or services you have requested from us. All information is held in the strictest of confidence; no third parties have access to your data except as directed by law. All information collected herein is stored on protected servers. To learn more about our privacy policy, please click here. By proceeding with your registration input, you acknowledge this privacy notice and afford permission for the CEC staff and/or its assigns to contact you as outlined above.

Please understand that we do not process any case file reviews on an 'urgent' basis. Please also note that incomplete or incorrect registrations will significantly delay processing of your file (e.g. incorrect email address, missing fields, etc.).

We are so glad you're here, and we look forward to hopefully being able to help! Thank you for taking the time to complete your form.

Date of birth *
Date of birth
Phone number (country code if outside USA)-required *
Phone number (country code if outside USA)-required




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Patient Forms


Patient Forms


The free Adobe Acrobat Reader is required to access and print our forms. If you do not have it, get it for free here.

CEC POLICIES

Please click here to access our policies regarding the following:

CEC Cancellation/No Show Policy for Office Appointments
CEC Cancellation/No Show Policy for Surgery
CEC Pain Management Policy
CEC Notice of Privacy Practices
CEC Travel Policy for our International & Out-Of-Town Surgical Patients
CEC Policy on Social Media Interaction
CEC Policy Regarding Administrative Fees
CEC POLICY REGARDING OUR NEW CREDIT CARD ON FILE REQUIREMENT

CEC FORMS

if you are: a first-time PATIENT with an in-office appointment date ALREADY SCHEDULED and YOU have been asked to download the 'new appointment' forms, Click here

if you are: a registered, prospective NEW patient undergoing OUR free RECORDS review (UNREGISTERED RECORDS WILL NOT BE ACCEPTED OR REVIEWED), click here NOTE: PLEASE DO NOT DOWNLOAD/SEND THESE FORMS WITHOUT REGISTERING FIRST. THANK YOU.

if you are: a post-operative patient and have been asked to download the 'CEC evaluation' form, click here

if you are: a post-surgical patient and have been asked to download the 'follow-up questionnaire' at least 6 months after the date of your surgery, click here

if you are: seeking a medical records release form to provide your doctor's office with in order to have them send us your records (sending of separate records must be approved by program director first), click here

if you are: a prior cec patient in need of additional copies of your records from us (two operative sets are provided TO YOU at POST-OP AT no cost) for another provider (charges will apply, see office policies above), click here

if you are: seeking a copy of our bowel prep instruction sheet (also provided at preop), click here

If you are: seeking a copy of our prohibited pre-surgical medication list (also provided in pre-surgical packet), click here

Si usted está: buscando una copia de nuestro documento de póliza de seguro en español, haga clic aquí