Patient Surgical Guide
What my patients will need to know before, the day of and the days after their surgical procedure.
What my patients will need to know before, the day of and the days after their surgical procedure.
For your convenience, you may complete the printable forms below and either fax them to our office ahead of time or bring them with you to your appointment. We recommend, in order to safeguard your personal information, that you do not e-mail these forms to us. If you have any questions regarding this process, please call our office.
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With this form you will provide the following information:
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With this form you will mark the areas on your body where you feel the sensations of:
We adhere to all local, state, and federal laws concerning release of patient information and patient privacy. Records (including X-rays) can be released with proper authorization from the patient or patient’s guardian. If you are being referred to another physician by Dr. Sampson, your records will be made available to the consulting physician.
2299 Post Street, Suite 107
San Francisco, CA 94115, United States
Office Phone:
1-415-345-9400
Office Fax:
1-415- 345-8049
Mon-Thurs: 9:00am-5:00pm (PST)