(302) 346-4000 | 200 Banning Street, Suite 110, Dover, DE 19904

Patient Forms

If not already provided by your surgeon’s office, please print out the necessary forms below in advance of your surgery appointment. This will ensure that we have all the necessary information to provide you with quality care and treatment. Just click on the link below for each form, print, fill it out, and bring it with you on the day of your surgery.

Download Forms

Notice of Non Discrimination  (Also available in: Spanish or Hatian Creole)

Authorization and Disclosures (Also available in: Spanish or Hatian Creole)

Pre-Operative Instructions

Patient Rights, Responsibilities

Advance Directive Notice 

Authorization to Release Medical Records

These forms require Adobe Reader. If you do not have this feature, you may download it free here.

Privacy Notice

This HIPAA privacy notice describes how health information about you may be used and disclosed, and how you can get access to this information.

Please review carefully.

COVID-19 Facility Update

In efforts to protect our patients, caregivers, and community from the spread of COVID-19, beginning Tuesday March 17 we will institute the following safeguards, screening process and visitation policy at Delaware Surgery Center.

Safeguards

If you meet any of the following criteria we ask that you postpone your surgery for at least 14 days.

 

 

 

Screening

 

Visitation

 

 

We appreciate your cooperation during this time.