Patient Forms

At West Bank Surgery Center, 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.

Advance Directive Acknowledgement

Download

Surgery Center Brochure

Download

Balance Billing Disclosure

Download

Contracted Providers Disclosure

Download

General Consents/Financial Responsibility

Download

Multiple Authorization Form

Download

Patient Rights and Responsibilities

Download

West Bank Owners

Download