Patient Questionnaires

The following patient questionnaires are available for your convenience in downloadable Adobe PDF format. You will need to have Adobe's free Acrobat Reader on your computer. Click here to Download the Acrobat Reader.

Please select the appropriate questionnaire to download, and fill it in prior to going to University Surgical Associates for your appointment.


  General Questionnaire
  Breast Cancer Risk Assessment
  Gallbladder Patient Questionaire
  Hernia Patient Questionnaire
  Obesity Patient Questionnaire
  Reflux Patient Questionnaire