Give Us A Call: 402.884.2450

Cost-Effective, Efficient, Safe Alternative To Outpatient Surgery Navigation
  • Home
  • About Us
    • Specialties and Procedures
    • FAQs
    • Careers
  • Physicians
    • Matthew Brumm, M.D. – Ophthalmology
    • Michael P. Cullen, D.P.M. – Podiatry
    • Carol A. Drake, M.D. – Ophthalmology
    • Gary Huang, M.D. – ENT
    • Evan Lenertz, D.P.M. – Podiatry
    • Eric Palmquist, D.P.M. – Podiatry
    • Nathan Penney, D.P.M. – Podiatry
    • Matthew Stottle, M.D. – Pain Management
    • Kelly Zach, M.D. – Anesthesiology & Pain Management
  • Patient Info
    • Patient Forms
    • Before Surgery
    • Day Of Surgery
    • After Surgery
    • Insurance and Payments
    • FAQs
  • Contact Us
    • Location and Hours
  • Make Payment
  • Home
  • About Us
    • Specialties and Procedures
    • FAQs
    • Careers
  • Physicians
    • Matthew Brumm, M.D. – Ophthalmology
    • Michael P. Cullen, D.P.M. – Podiatry
    • Carol A. Drake, M.D. – Ophthalmology
    • Gary Huang, M.D. – ENT
    • Evan Lenertz, D.P.M. – Podiatry
    • Eric Palmquist, D.P.M. – Podiatry
    • Nathan Penney, D.P.M. – Podiatry
    • Matthew Stottle, M.D. – Pain Management
    • Kelly Zach, M.D. – Anesthesiology & Pain Management
  • Patient Info
    • Patient Forms
    • Before Surgery
    • Day Of Surgery
    • After Surgery
    • Insurance and Payments
    • FAQs
  • Contact Us
    • Location and Hours
  • Make Payment

Patient Forms

ASC-patient-forms-smallPlease click on links below to view patient information.

  • Privacy Statement
  • Patient Rights
  • Advance Directives
  • Medication / Reconciliation Form
  • Medicare Secondary Payer (MSP) Questionnaire
  • Release of Patient Information Consent

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Miracle Hills Surgery Center | 11819 Miracle Hills Dr, #201, Omaha, NE 68154
Office 402.884.2450,Fax: 402.884.2455 | About ASCs | No Surprises Act - Billing Disclosure | Good Faith Estimate