|The Center for Outpatient Medicine||2502 East Empire Street Suite B||Bloomington, IL 61704|
|Phone: 309.662.6120||Toll Free: 800.466.8275||Fax: 309.663.8972|
Each TCOM patient is required to fill out three forms, an initial Registration Form, a Patient Pre-Anesthesia and Surgery Questionnaire, and a Medication List.
Please send these forms as soon as possible, and be sure to fill out all 3.
If convenient, you may download a PDF version of each form:
Click on the forms below to print them out. PDF forms are not fillable online, rather they must be printed out and hand written. All three forms must be completed.
After completing all three forms, please fax them to (309) 663-8972. Once TCOM receives your paperwork, we can register you and determine if you need pre-testing (for example, blood work, EKG, and /or an appointment with an anesthesiologist) prior to your surgery date.
For more information about surgery preparation, you can view the Patient Information Packet.