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Doctor Checking a Form

Online Admission Form  

Pacific Day Surgery uses an online, cloud-based program for admitting patients to our hospital for surgery.

The admission forms will take approximately 15 minutes or less to complete online.  

 

Please have the following information ready: 

  • Date of surgery

  • Health insurance details

  • Medicare number

  • Your full name

  • Your residential address (Not a P.O Box)

  • Contact information for yourself and your pick-up person (for patients undergoing general and neuroleptic sedation)

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 Complete the online form by clicking button below

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