Surgery Center Patient Forms

Click on the name of the form you wish to print. All forms may be printed and/or saved on your computer.

Anesthesia Informed Consent and Risk Disclosure Form

Outpatient Discharge Instructions

Ophthalmic Discharge Instructions

Pre-Admit Form to be completed by patient prior to pre-admit appointment

Receipt of Valuables

Request for Specialized Treatment or Procedure

Patient Satisfaction Survey (This is a fillable form in Microsoft Word)

Patient Satisfaction Survey (This is a PDF printable form)

Adobe Acrobat is required to open the documents above. To install Adobe on your computer, click on this link: Adobe Acrobat Reader