Click the link below for a Financial Partnership Form. Please sign this form and bring it with you on the day of your surgery.

• Financial Partnership Form

Admission and Cost

• Prior to your visit, you will be contacted regarding your insurance and payment arrangements.
• PLEASE NOTE:  Patients are asked to pay their co-payment and any deductible, if applicable, the day of surgery unless other arrangements have been made in advance.
• Please bring your current insurance card and photo ID.
• For your convenience, we do accept Visa, Master Card, Discover Card and American Express, Personal Checks, Cashier’s Checks and cash.
• Not included in the Center’s fees are the services of our Surgeon, Anesthesiologist and Pathologist.
• We want to inform you that your SURGEON may have an ownership interest in the surgery center. Your surgeon _________does have an ownership interest in the Surgery Center and you will be asked to sign an acknowledgment that you were informed of this when you come to the center. Your surgeon_________does not have ownership.
• Before admission each adult patient should review:
  A. Patients Bill of Rights
  B. Advance Directives Information:  An Advance Directive or Living Will is a legal document signed by you about how you want your healthcare decisions handled and who you want to make decisions for you in the event that you are unable.  For more information and forms contact www.dgcenter.org / or call 480-966-2674.  Information and forms can also be obtained at the Center.  If initiating an Advanced Directive it must be completed, and witnessed prior to day of surgery.

*If you have a Living Will or Advanced Directive, please bring a copy with you the day of surgery.* 

The Advance Directive will be on file, however our policy is to suspend the Advanced Directive during your procedure at the Center.  If you have any questions call the Center.