Patient Forms
New Intake Patient Forms
If you are a free records review case, or have a new patient appointment in the office, or have been scheduled for a new patient telehealth, please —> access the required forms here <— (forms #1). You will need to print and complete them and return them to the cec with your related materials.
Other forms & information:
If you are:a CEC patient who has undergone surgery with us, please complete our 'CEC team evaluation' feedback form by clicking here. Many thanks for sharing your initial impressions and evaluation!
If you are:a post-operative CEC surgical patient who is at least 6 months out from your surgery date (preferably 12+ months), please click here to provide your post-surgical follow-up information. Thank you to the countless cec patients who generously provide their feedback and help us maintain our patient follow-up data.
If you are:seeking a copy of our bowel prep instruction sheet (provided at preop), click here.
Click here if you need a records release form from the cec to provide records to yourself or another physician. Click here if you need a records release form to the cec for your physician to release records to you for the purposes of your surgical consult with us.
Si usted está: buscando una copia de nuestro documento de póliza de seguro en español, haga clic aquí.
Free Case Review
Both Dr Sinervo and Dr Eugenio-Colon provide free case evaluations. You are free to choose either surgeon, or “no preference” if you do not have a specific request. Please note that case reviews are not conducted on a rush basis; all evaluations are given the full and careful attention they deserve in the order in which files are received. Case reviews may take as long as 4 weeks in some circumstances before hearing from the reviewing surgeon, as they are conducted on the basis of the reviewing surgeon’s availability. Thank you for understanding.
We appreciate you taking the time to read through all of the above and the subsequent email information you will receive shortly. We are very grateful for the time and effort you will put into gathering your package for the privilege of our review; we know you have a choice of surgeons and are very honored to be among those you are considering for your care.
Regrettably, we are unable to process any submissions that are missing or contain erroneous data (e.g., incomplete address, incorrect email), so we kindly ask you to double-check your entries. Thank you for helping us to efficiently help you or a loved one!