Surgery Center

Forms To Bring To Pre-Surgical Screening

Please gather the required information and complete the forms listed below. Bring the completed forms with you to your pre-surgical screening appointment.

  1. Photo ID

  2. Medical Insurance Cards: Bring these to your pre-surgical screening appointment and on the day of your procedure. Note: Please call your insurance company before your procedure to ensure you have accurate information about coverage, and you've obtained any authorizations that are required.

  3. All paperwork that was sent to you or given to you by your doctor or surgeon

  4. Living Will: Bring a copy if you have one.

  5. Pre-Admission Form

  6. Health Care Proxy

  7. Patient Medication List

Surgery Center

Phone: (585) 341-6707
Hours: Mon-Fri, 7:30 - 4

Forms