Information

Lake City Surgery Center
404 NW Hall of Fame Drive
Lake City, FL 32055
Ph: 386-487-3930
Fax: 386-487-3935

Accreditations

AAAHC

AHCA
Patient Forms
Forms All personal information collected and submitted on this site are for our Patient's convenience and is secured with a Standard SSL Certificate with 128 bit encryption.




NOTE: To fill out all Patient Information forms online please START HERE and it will take you through the form process. There are ten forms and as you fill out and click submit it will take you to the next form. It only takes a few minutes but will save you time at your office visit or right click your mouse on Download PDF and Save Link. Print, fill out, and bring to your first appointment. ALL QUESTIONS AND INFORMATION ASKED MUST BE ANSWERED. IF YOU ARE UNSURE PLEASE PUT NA IN BOX.

Individual Patient Forms
1.Patient Data (Online)                                                                          DOWNLOAD PDF PDF
2.Patient Rights (Online)                                                                     DOWNLOAD PDF
3.Permission Form (Online)                                                                 DOWNLOAD PDF PDF
4.Disclosure Authorization (Online)                                                    DOWNLOAD PDF PDF
5.Privacy Practices (Online)                                                                 DOWNLOAD PDF PDF
6.Advanced Directives (Online)                                                            DOWNLOAD PDF PDF
7.Latex Allergy (Online)                                                                         DOWNLOAD PDF PDF
8.Sleep Apnea (Online)                                                                          DOWNLOAD PDF PDF
9.Surgery Instructions (Online)                                                            DOWNLOAD PDF PDF
10.Anesthesia Questionnaire (Online)                                                 DOWNLOAD PDF PDF
11.Credit Card Pre-Authorization                                                             DOWNLOAD PDF PDF