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503 874 0574

Falls Canyon Surgical Associates

Falls Canyon Surgical Associates

  • Home
  • About
    • Liska L. Havel, MD, MPH
    • James P. Nealon, MD, FACS
  • Patients
    • New Patients – Getting Started
    • Billing
    • Forms
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    • MyChart – Health Portal
  • Preparation
    • Surgery Preparation
    • Colonoscopy Preparation
  • Procedures
    • Appendectomy
    • Colonoscopy
    • Cholecystectomy
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Patient Forms and Procedure Instructions

📋Patient Forms and Procedure Instructions

Please read each form title carefully before downloading. Many of our forms are intended for specific appointments, procedures, or situations. Selecting the correct form helps ensure you complete the appropriate paperwork and prevents delays in your care.

New Patients

All new patients to our clinic are required to fill out:

  • Patient Demographics Form
  • Health History Questionnaire
  • Medications and Allergies Form

Established Patients

Established patients that we have not seen in more than a year must fill out:

  • Page 2 of the Health History Questionnaire
  • Medications and Allergies Form

Patient Demographics Form

Patient Demographics Form (English)
Patient Demographics Form (Spanish)

Health History Form

Health History Questionnaire (English)
Health History Questionnaire (Spanish)

Medication and Allergies Form

Medications and Allergies Form (English)
Medications and Allergies Form (Spanish)

📄Procedure Instructions and Forms

Download the official procedure preparation instructions below. Please read and follow all instructions carefully before your procedure.

Colonoscopy Bowel Preparation/Instructions

Miralax Prep

Miralax – Colonoscopy Instructions (English)
Miralax – Colonoscopy Instructions (Spanish)

Suflave Prep

Suflave – Colonoscopy Instructions (English)
Suflave – Colonoscopy Instructions (Spanish)

Sutab Prep

Sutab – Colonoscopy Instructions (English)
Sutab – Colonoscopy Instructions (Spanish)

Golytely Prep

Golytely – Colonoscopy Instructions (English)
Golytely – Colonoscopy Instructions (Spanish)

General Surgery Pre-Op and Post-Op Instructions:

General Surgery Instructions (English)
General Surgery Instructions (Spanish)

Breast Surgery Instructions:

Breast Surgery Instructions (English)

Colon Surgery Instructions (NOT COLONOSCOPY):

NO PREP – Pre-Op Colon Surgery (English)
Miralax – Pre-Op Colon Surgery (English)
Suflave – Pre-Op Colon Surgery (English)
Suprep – Pre-Op Colon Surgery (English)

Hemorrhoidectomy Instructions:

Hemorrhoidectomy Instructions (English)

Constipation Protocol:

Constipation Protocol (English)
Constipation Protocol (Spanish)

Hibiclens Pre-Surgery Wash Instructions:

Hibiclens Pre-Surgery Wash (English & Spanish)

Hospital Campus Maps

Silverton Hospital Campus Map (English)
Silverton Hospital Campus Map (Spanish)

If you have any questions about which forms to fill out, how to return them, or if your forms are missing from this list, please call our office at 503-874-0574. We’re happy to help!

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