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The Hospital at Westlake Medical Center Forms

The Hospital at Westlake would like to make your experience with us as smooth as possible. Please feel free to print out and complete these forms as directed by hospital personnel prior to arriving for your appointment.

All links are downloadable PDF files. Simply click to open or download the file(s) to your computer.

Medical Records

Download PDF  Release of PHI Authorization Form

 

Human Resources

Download PDF  Hospital Application

 

Surgery

Download PDF  Pre-Op Patient Assessment Questionnaire (PDF - Complete and fax to (512) 697-3715)

Download Word Document  Pre-Op Patient Assessment Questionnaire (DOC - Complete and fax to (512) 697-3715)

 

Sleep Center

Download PDF  Physician Order Form

Download PDF  Instructions for New Patients

Download PDF  Patient Sleep Questionnaire

Download PDF  Sleep Diary Table Form

Download PDF  Bedpartner's Questionnaire

Download PDF  Day of study pre-sleep questionnaire

Please print form 1 then give it to your physician to place the order. After your order has been confirmed print forms 2-5, fill them out to the best of your ability. The "Sleep Diary" is a week long history of your sleep habits please keep this in mind when scheduling your appointment. You may bring all of the paperwork with you the night of the study. This paperwork is very important as it helps to analyze your specific sleep needs. If desired you may scan the completed forms and email them to: (sleeplab@westlakemedical.com) or mail them to: 5656 Bee Caves RD Austin, TX, 78746 Suite M302 Attn: Sleep Lab (All forms must be mailed out at least 5 days prior to your scheduled study to insure we receive them before testing), Form 6 should be filled out the day of your study pertaining to the night before and that day. Thank you, we look forward to assisting you in a better more restful nights sleep. For scheduling or cancellations call: 512-697-3712 for non scheduling related questions call 512-697-3740 Monday through Friday 9:00 am to 4:00 pm, after hours please leave a message and someone will return your call.

 

Rehab and Wellness

Download PDF  Hand Therapy Medical History

Download PDF  PT-Patient Medical History

 

Advanced Directives

Download PDF  Information on Advance Directives

Download PDF  Texas Medical Power of Attorney

Download PDF  Directive to Physicians and Family or Surrogates

Download PDF  Out-of-Hospital Do Not Resuscitate Order

 

Case Management / Social Services

Download PDF  Medicaid Application

 

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