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Campus Surgery CenterCampus Surgery Center

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Patient Forms

At Campus Surgery Center, your time is as valuable to us as it is to you. Upon scheduling your surgery, a member of our staff will provide you with the required forms to fill out. We encourage you to take time to complete these before arriving on day of surgery, so that we may care for you promptly. If you happen to misplace any of the provided forms, duplicates are available for download and print below.

*You may print and complete, however you cannot sign the documents prior to checking in at the Surgery Center.

Our Patient’s Safety During COVID-19

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Anesthesiologist’s Assignment of Benefits

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Our Commitment to Each Other: Patient & Provider’s Mutual Responsibilities During COVID

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Pain Medicine Patient Health History

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*Consent for Admission

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*Medicare Short Form (for our Medicare patients only)

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Privacy Notice

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Patient Rights and Responsibilities

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Financial Policies

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Patient Health History

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Our Patient’s Safety During COVID-19 Keeping You Safe During COVID-19 How To Prepare For Surgery Patient Forms Insurance and Billing CareCredit Visitor Information Prevention Information Recovery Information Request an Appointment
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Campus Surgery Center
901 Campus Drive, Ste 102,
Daly City, CA 94015

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