PRE-REGISTRATION

Thank you for choosing Ashland Surgery Center for your upcoming procedure or surgery. In order to expedite your registration process, please print out and complete the following forms, if you have not already done so.

When you arrive at Ashland Surgery Center our registration staff will review the forms and verify your insurance information. Please bring all of your insurance cards, photo ID and the completed registration forms with you. If you have a co-pay or balance you will be asked to pay at the time of registration. The Surgery Center is committed to ensuring patient safety. Beginning with the registration process, several staff members will ask you to identify yourself and verify the planned procedure. Please be patient and remember that we are doing this to ensure your safety.

The following forms should be completed prior to your scheduled procedure. (Click on each button to download a printable form.)

Welcome Letter Registration Packet Financial Policy Patient Bill of Rights Notice of Privacy Practices

You will need Adobe Acrobat Reader to view and print these forms.

MD Disclosure

Ashland Surgery Center is owned by five local physicians: Dr. Chow, Dr. Epstein, Dr. Ewing, Dr. Welder and Dr. Herron who also perform procedures at the ASC. If you have any questions regarding this or wish to have your procedure at another facility please contact your physician. Thank you for choosing Ashland Surgery Center.