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.

*Consent for Admission

HIPAA Release Form

Anesthesiologist’s Assignment of Benefits

Patient Health History

Pain Medicine Patient Health History

Financial Policies

Patient Rights and Responsibilities

Privacy Notice

*Medicare Short Form (for our Medicare patients only)