Patient Forms and Instructions: Download and Print

If you are unable to complete the forms electronically HERE, please print them out and email the completed documents to info@thesternbergclinic.com

To review our privacy practices, click HERE

New Patient Form

If you wish to be a new patient at The Sternberg Clinic, and have an issue other than a pilonidal problem, please complete a patient history form as well as the Office and Financial Policies.

New Pilonidal Patient Forms

Are you a new patient looking be evaluate for a Pilonidal condition at The Sternberg Clinic? Please complete a New Pilonidal Patient Questionnaire and Office and Financial Policies to provide our office staff with your information and medical history.

General and Colon and Rectal Surgery Instructions

Read our General Surgery and Colorectal Surgery FAQ section if you are a patient at The Sternberg Clinic preparing for a general or colon and rectal surgery procedure.

For post-op instructions, please download and refer to our Post Op documents: 

Lump and Bump Post Op Instructions PDF document

AnoRectal Post Op Instructions PDF document

Pilonidal Cleft Lift Surgery
Post-Operative Instructions

If you have undergone surgery for Pilonidal Disease, read this document to prepare for surgery and plan your recovery after the operation. Download and Print

Download a copy of the Closed Suction Drain Output Record.

General Surgery
Patient Instructions

Anal Fissure Treatment Plan

An anal fissure is a ‘cut’ in the anal canal resulting from trauma. Most people suffering from an anal fissure experience pain during or after defecation (the act of moving one’s bowels, a number 2). Download and Print

Nitroglycerine​ ​Ointment​ ​0.2%

If you’ve been prescribed nitroglycerin ointment for your anal fissure, read our instructions for use. Download and Print

Rubber​ ​Band​ ​Hemorrhoid​ ​Ligation

You just had a rubber band or bands applied to you internal hemorrhoids. Here are a few things to be aware of. Download and Print

Suggestions​ ​for​ ​perianal​ ​care​ ​in​ ​patients​ ​with​ ​itching​ ​or irritation

Read our suggestions for patients with perianal itching and other anal symptoms or conditions that can contribute to anal itching or discomfort. Download and Print

Taking​ ​a​ ​Fiber​ ​Supplement

There are many fiber supplements and all can be purchased without a prescription. Read our information sheet on how to select and use a fiber supplement. Download and Print

Thrombosed​ ​or​ ​Prolapsed​ ​Hemorrhoids

For patients with severe, circumferential thrombosed hemorrhoids and/or prolapsed hemorrhoids there are two primary treatment options. Download and Print

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