When scheduling your consultation appointment, please alert the office if you have a medical condition that may be of concern prior to surgery. This information will allow us to schedule an appropriate amount time with the doctor.

Please assist us by providing the following information at the time of your consultation:

• Your surgical referral slip, if applicable.
• If your dentist or physician has taken recent x-rays, request that they forward the films to our office. If there is not enough time for them to send the films, please pick up the x-rays and bring them with you. If additional films are necessary, they can be taken at our facility.
• A list of medications you are presently taking.
• If you have lab results or other information that may be helpful, please bring that information with you or request that it be sent to our office.
• Please bring your photo ID.
• If you have medical or dental insurance, bring your cards and identification information. We will file all claims on your behalf.

IMPORTANT: All patients under the age of 18 years of a must be accompanied by a parent or guardian at the consultation visit.

Filling out our forms prior to your appointment can save valuable time and make your office experience smoother and more comfortable. All new patients will need to print and fill out the following forms:

Please read your pre-op instructions carefully. If your surgery is being performed under general anesthesia, there are restrictions that must be followed including arriving on an empty stomach and having a responsible adult drive you to and from your appointment. If you have any questions in regards to your pre-op instructions, please call the office 814-235-7700.

Please read your post-op handout carefully and keep it as a reference for after surgery. Every surgical procedure is different, so not all of the instructions may apply. Common sense will often dictate what you should do. When in doubt, or if you have any questions not addressed, please do not hesitate to call 814-235-7700.

Patient Bill of Rights

Our goal at Centre Oral & Facial Surgery is to make your experience with us the best it can be. We offer only the highest quality care and want you to know that we acknowledge and respect your rights as a patient as listed below.

1. You will be treated with consideration, dignity and respect.
2. You have the right to privacy regarding your consultation, treatment plan and finances.
3. You have the right to confidentiality of your records and disclosures, and except when required by law, you are given the opportunity to approve or refuse their release and request restrictions on their use and disclosure.
4. You will receive complete information concerning your diagnosis, evaluation, treatment plan and prognosis. (If medically inadvisable to release this information, it will be provided to a parent or guardian, power of attorney, or responsible adult.)
5. You can participate in decisions involving your care.
6. You have the right to access and copies of your protected health information (with exceptions) and upon written request, amendments of your protected health information.
7. You have the right to an accounting of disclosures of your personal health information.
8. You have the right to change doctors.
9. You have the right to information concerning your patient rights. The following information will be included in your new patient orientation packet during your consultation visit:
   1. Your responsibilities as a patient.
   2. Other services available to you through this office.
   3. Provisions for after-hour emergency care.
   4. Information concerning fees for services.
   5. Information concerning payment policies available through this office.
   6. The right to decide whether to participate or to refuse participation in any research.
   7. The right to express grievances or offer suggestions. Patient satisfaction surveys are available upon request.