We have provided some of the patient forms you may need for your surgical center appointment. For the protection of your information, these forms cannot be filled out online at this time, but you can download the form and fax it back to us on the secure fax line (949) 988-7889.
Pre-Admission Forms
- Patient Registration
- Medical Reconciliation
- Pain Diagram
- Patient History Questionnaire
- Patient Rights and Responsibilities (English)
- Patient Rights and Responsibilities (Spanish)
- General Consent
- Insurance Appeal Payment Agreement
- DISC Policy on Advanced Directives (Spanish)
- Release of Medical Information
Notice To Consumer: All physicians and vendors are independent and not employees of the Ambulatory Surgical Center.
Notice to Patients: Medical doctors are licensed and regulated by the Medical Board of California. To check up on a license or to file a complaint go to www.mbc.ca.gov, email: licensecheck@mbc.ca.gov, or call (800) 633-2322