Patient Forms

Please review the forms listed below in advance of your appointment.

Notice Informing Individuals about Nondiscrimination and Accessibility Requirements

Aviso informado a personas los requisitos de accesibilidad y no discriminiación

Financial Ownership Disclosure

Surgery Center Medical Staff and Healthcare Practitioners 

Patient Rights Under Florida Transparency Act of 2016

Patient Privacy Notice

Patient’s Statement of Rights and Responsibilities

Pre-procedure Information for Patients

Ambulatory Surgery Center Prices and Performance Data

The Agency for Health Care Administration (AHCA) data on ambulatory surgery center pricing and performance is available on the Internet on The Agency for Health Care Administration Web site. Pricing and performance data provided by AHCA is a compilation of charges for the average patient and is a non-personalized estimate of costs based on your anticipated services.  Your actual costs and bill from the Surgery Center may vary from the average depending on a number of factors and will be based on services actually provided to the patient.