Patient Forms

At Surgery Center of South Central Kansas, 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.

Patient Information Sheet

Download

Eye Surgery Patient Information

Download

Financial Agreement

Download

Notice of Privacy Practices 2013

Download

Patient Information

Download

Medication List

Download

Patient Rights and Notification of Physician Ownership

Download

Rate Your Pain

Download