Patient Registration and Health History for the Mayfield Spine Surgery Center
> Patient Registration
Register here for both pain procedure and spine surgeries
We’re here to give you the best possible outcome.
To do that, we need you to provide us with your health information and medical history prior to your procedure. All of your medical information is confidential, and used only to provide you with
the best care possible.
Who should complete the health history form?
Everyone except those individuals who have had surgery at Mayfield Spine Surgery Center within the last six months AND who completed this online form before that procedure.
How long will it take to complete the health history form?
Your medical history plays a big role here.
An average of 15 minutes for a personal who is healthy and not taking any medications
Longer for someone with a longer or more complicated medical history
A staff member or nurse may call you for further clarification if necessary.
What information do I need to be able to complete this form?
Before you start the process, please have the following information handy.
It’s critical that you list all medications you take and are prescribed, including those you may have stopped taking in preparation for your procedure. Even if you’re already a patient with us, please fill this section out completely.
- Prescription medications: Names and dosage of each one you take.
- Over-the-counter medication: Names and dosage of each one you take regularly.
- Vitamin and herbal medications: Names and dosage of what you take.
- Allergies/Sensitivities you have, and the allergic reaction(s) they cause.
- Previous surgeries and the year they were performed.
- Medical Insurance: Insurance company, policy number, ID number, group number, and so on.
Complete your health history form
Rest assured, this online form is easy and secure.
COVID-19 Policy
Mayfield Spine Surgery Center is observing the CDC’s recommended preventive actions to help prevent the spread of respiratory diseases, including COVID-19. Our number one priority is the safety of our patients and staff.
