Skip to main menu Skip to main content Skip to footer

Patient Forms

Once your appointment with St. Charles Surgery Center is scheduled, please print and complete the following patient forms. This information will help our clinical team to prepare for your surgery.

Patient Rights and Responsibilities

This privacy notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Privacy Rule

Most of us believe that our medical and other health information is private and should be protected, and we want to know who has this information. The Privacy Rule, a Federal law, gives you rights over your health information and sets rules and limits on who can look at and receive your health information. The Privacy Rule applies to all forms of individuals’ protected health information, whether electronic, written, or oral. The Security Rule is a Federal law that requires security for health information in electronic form.

Opioid Information

Talk to your health care provider about how to treat your pain and create a safe and effective plan that is right for you. You may click here for important information regarding the use of prescribed opioids.

Contact Us

If you have questions for a physician, please contact them directly.

If you have questions related to St. Charles Surgery Center, please fill out the form below and a member of our team will contact you.