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Thank you for choosing the Crozer-Keystone Surgery Center at Brinton Lake for your surgical procedure.

To make it easy for you to start the pre-surgical assessment process, The Crozer-Keystone Surgery Center at Brinton Lake requests that you fill out your medical history online with One Medical Passport as soon as your surgical procedure is scheduled. One Medical Passport is a secure website that enables you to enter your medical history online at your convenience, but prior to your surgical procedure.

Secure, HIPAA Compliant

One Medical Passport, which is HIPPA-compliant, uses the highest grade of Internet security available. Your information will be released only to your medical team at the Crozer-Keystone Surgery Center and will never be released to anyone other than your medical team.

Easy to Use

Completing your medical history online using One Medical Passport is easy, and for most patients, takes less than 30 minutes. Please fill out the questionnaire accurately and completely. At any time, you may stop filling out the questionnaire and return to complete the form at a more convenient time.

Need Help?

Need to contact One Medical Passport directly? Already a Passport user but need help with your username and/or password? Get help here and see 'Already Have a Passport?' at the bottom left of the page.

Filling Out the Online Form

To begin, access One Medical Passport here.

Be sure to have the following information available before you start to fill out the online form:

  • Your health insurance information
  • The names, addresses and phone numbers of your physicians
  • A list of all medications you are taking, their dosage and frequency
  • A list of surgical procedures you have ever had
  • The name of the surgeon who will be performing your upcoming procedure

After you complete your medical history online, you will be able to print out a copy of your medical history and keep it for your records. In addition, you will be able to access your medical history online to review or update it.

Pre-Surgical Assessment

The Crozer-Keystone Surgery Center at Brinton Lake requests that you fill out your medical history securely online with One Medical Passport as soon as your surgical procedure is scheduled. Click the link below to fill out the form.

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Learn more about One Medical Passport.