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Patient Forms

You will receive a call from our nursing team a few days before surgery to review your medical history and answer any questions. Please feel free to call us before or after your procedure should you have any questions. We will be happy to speak with you. To speed up your registration process, you may download the following forms. Please fill them out and bring them with you on the day of your procedure.

Patient Demographics & Financial Agreement

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Patient Health Questionnaire

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Medication Reconciliation Form

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Patient’s Rights and Responsibilities (English)

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Patient’s Rights and Responsibilities (Spanish)

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Premier Outpatient Surgery Center
1003 E. Brier Drive, Suite #170,
San Bernardino, CA 92408

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