Surgery Paperwork

Please click on the link below and complete the ONLINE surgery form required for your surgery. The link will take you to the Simple Admit page where you will be able to submit it online. 

PATIENT ONLINE SURGERY FORMS SUBMISSION

via Simple Admit click here  ► PATIENT FORMS

 

 

 

For downloadable pdf paper Patient Forms click here ►PATIENT FORMS

In order to view and print these forms you will need Adobe Acrobat Reader installed. Click here to download it  

Forms are best downloaded and viewed with Internet Explorer  

If using , make sure to open the Surgery Forms within Adobe Acrobat Reader and NOT within the Chrome browser

If you use Microsoft Outlook program  for email, you may submit the forms directly to the surgery center by clicking on the "Submit Forms via Outlook" button on the last page. 

 

 

FOR PATIENTS WHO HAVE AETNA OR UNITED HEALTHCARE

We have partnered with Alliance Med, LLC for meeting our patient's ever changing insurance needs.

Alliance Med provides:

  • An experienced team to handle all aspects of your Out of Network claim including:
    • Verification of your insurance benefits
    • Billing and Claims Processing
    • Ensuring that your insurance company  is covering all the benefits that your policy has, and utilizing your Out of Network benefits
  • Before surgery, the Patient Choice Advocate will provide Education for our patients concerning their insurance benefits
  • The Patient Choice Advocate will work with our patients who need surgery but may be under unique circumstances, which may make paying for surgery difficult
  • The Patient Choice Advocate from Alliance Med will contact you prior to your surgery date to discuss your benefits. if you have questions, please call 1-877-415-8682

 

 In order to view and print these forms you will need Adobe Acrobat Reader installedClick here to download it  

 Forms are best downloaded and viewed with Internet Explorer  

 If using , make sure to open the ALLIANCE MED FORMS within Adobe Acrobat Reader

 

 

 

 

 

 

Doctors Office use only: Surgeon's Forms