New Patient Forms

Thank you for considering Ventura Advanced Surgical Associates as your healthcare provider. As part of our commitment to our patients, we strive to provide the highest standards in evaluation and treatment. In order for us to meet those standards, it is imperative that we obtain a detailed medical history from each of our patients.

Please take the time to address and answer each question as they are all important in completing your evaluation. The entire document will be reviewed with you at your initial consultation and will continue to provide important information for our physicians and nurses throughout your preoperative workup.

Our patient history form includes a comprehensive sleep questionnaire. Obesity increases the risk of sleep apnea which may cause or exacerbate diabetes and hypertension. Sleep Apnea may also increase the risk of postoperative complications. If we determine that you have sleep apnea we initially treat the condition before any surgery to decrease your risk of postoperative complications.

Once we have a complete medical history and sleep questionnaire, we can proceed with your initial consultation.

Medical Release Form

New Patient Forms
Please fill out the information requested on the attached forms.

MBSQIP

Gastric Bypass Surgery

Patient Portal

Patient Portal

We are pleased to provide patients with secure, 24/7 access to their health records through the Patient Portal. Patients can safely and easily:

  • Request prescription refills
  • Update insurance/demographic information
  • Review financial statements/make secure payments
  • View lab and test results
  • Access relevant health education materials

Patient Portal Login

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