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Pre-Admission Registration

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For your convenience Melbourne Surgery Center is now offering online pre-admission registration for your surgery.  Registration is designed to be fairly quick and easy. Completion the should take you 10-15 minutes.  Please have your medical history and medication information handy for reference.

 

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)

Advanced Directives

Ownership Disclosure and Attestation form

Aviso De Practicas de Privacidad

Notice of Privacy Practices-English

Notice of Privacy Practices-Spanish

Anti-Discrimination-English

Anti-Discrimination-Spanish