ALA Surgery
2801 Blue Ridge Road
Suite 101
Raleigh, NC 27607

Dr. Joseph C. Moran

Bariatric Surgeon

Medical Director of Bariatric Surgery at Rex Hospital in Raleigh, NC

Patient Forms

The forms listed below should be completed prior to your office visit for timely service:
(You may access the forms by clicking on the name of each form.)

• ALA Financial Policy
• New Patient Information
• Notice of Privacy Information
• Patient Insurance Coverage Agreement
• Receipt of Hippa Notice
• Initial Bariatric Physical Patient Questionnaire Form
• Assignment Uniform

Other Forms (Medical Records Release / Continuation of Care):

• Medical Release Information [1] (Consent for ALA Surgery to relay medical information to voicemail, spouse, etc...)
• Medical Release Information [2] (Consent for ALA Surgery to release medical information to another doctor/hospital.)
• Medical Release Information [3] (Consent for another doctor/hospital to release medical information to ALA Surgery.)
• Continuation of Care

Accepted Insurances

We accept most major insurance plans, including:

• Aetna
• Medicare (Accepted for general surgery only.)
• Blue Cross Blue Shield
• Cigna
• United Healthcare Medicare
• Primary Physician Care
• First Health
• Medcost
• Great West
• Well Path
• Medicaid (Accepted for general surgery only.)
• PHCS
• Humana Gold