Please click on the document links below as they are required by all patients to be reviewed and attested to prior to surgery. The Patient Attestation Form is provided for convenience below and is required for all patients as part of the Center for Medicare's ASC Conditions of Care requirements regardless of your insurance carrier.
Please print, complete, sign and return the attestation form in advance via fax @ 321-729-6463 or bring with you on the date of your surgery .
Patients Rights and Responsibilities
Patients Rights and Responsibilities (Spanish)
Ownership Disclosure and Attestation form
Aviso De Practicas de Privacidad
Notice of Privacy Practices-English
Notice of Privacy Practices-Spanish
95 Bull Dog Blvd., Ste 104
Melbourne, FL 32901