Patient Documents

Perioperative Flow Sheet

Pre-Operative Instructions

Patient Satisfaction Survey

Patient Rights and Responsibility

Advance Directives

Safety Awareness



**The above documents can be downloaded by clicking on the link, and choosing to save or open the document. If you are asked to complete and submit any of these documents, you may do so by filling them out online and emailing them to  Or, you can print them out, complete them manually and fax them to (863) 618-1101.







325 Avenue B, NW, Winter Haven, FL 33881 Phone: 863.291.4000 Fax: 863.299.9179
Winter Haven Ambulatory Surgical Center, LLC 2003
Legal | Medical Information | Confidentiality | HIPAA Privacy Notice