Completing the patient form prior to surgery saves patients time and helps make the process run smoothly.

Patient Surgical Information Form

The Surgical Information Form for patients who are going to have surgery at Quail Surgical and Pain Management Center is below.

Pre-Surgery Screening

Please complete the online pre-surgery screening form below prior to your scheduled surgery at Quail Surgical and Pain Management Center. All information is submitted securely. If you have any questions, please call the Center at 775-827-7555.

  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • Please select all that apply. If you have no past issues (or if none apply), please select "No Past Issues".
  • This field is for validation purposes and should be left unchanged.