Pre-Registration Form
Please fill this form out to pre-register at the surgical center.
Form information
This is a long and extensive form and will require all items to be filled out. Do not fill out this form in a public space or public device. It is the patient’s responsibility to ensure that they do not save their information to the web browser. The patient has a right to fill out the form on paper and you can request one from the office. Patients should only use their personal devices when filling out the form. They should not fill out the form in a public place as the form does require sensitive patient information.
See below for more information on the pre-registration form
More Pre Registration Information
The Tresure Coast Surgical Center website has an embedded form from Google on the site which handles the form for our pre-registration. Our website only provides an embedded link to the form. The Treasure Coast Surgical Center has a Business Associate Agreement with Google in accordance with HIPAA regulations. Additionally, the services we use meet HIPAA compliance in accordance to the HIPAA Security and Privacy Rules. The website also has other secruity measures in place such as a digitial security certificate, malware protection and more. There is no 100% gurantee that a security breach cannot occur. Rules and guidelines are in place in the event of a breach and the appropriate persons will be notified in the case of such event including authorities and patients affected as stated by HIPAA.
It is the patient’s responsibility to not fill out the form in a public space and/or public device. It is the patient’s responsibility to ensure that they do not save their information to the web browser. They must also be careful when filling out the form as it is a long and extensive form. The form should not be left uncompleted on their device or leave an uncompleted form unattended.
The Treasure Coast Surgical Center holds no responsibility if the patient fails to do their due diligence in filling out this form. The patient also has a right to fill out the form on paper and you can request one from the office.
The Treasure Coast Surgical Center will continue to endeavor to be HIPAA compliant. We ask that any patients who have questions or concerns contact the office.