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St. Peters Ambulatory Surgery Center

Downloadable Forms

The documents below will provide you with important information about your rights as a patient at St. Peters Ambulatory Surgery Center. Please review them carefully prior to your visit with us. If you have any questions, please do not hesitate to contact us at (636) 928-1670.

  • icon Advance Directive information
    This document provides the health care team members information to assist them in working with patients who have Advance Directives such as a living will, healthcare surrogate or proxy appointment, or durable power of attorney.
  • icon HIPAA Privacy Notice
    Click here to review our center's HIPAA privacy notice.

  • Disclosure of Financial Interest
    If your physician has scheduled your procedure at the Surgery Center, he believes that it will be an appropriate and therapeutic setting for your procedure and in your best interest. However, in the interest of full disclosure, we want you to know that there are other facilities where your physician could perform your procedure.

  • icon Patient Responsibilities
    As a patient of the St. Peters Ambulatory Surgery Center, we ask that you take a moment and review the following responsibilities.

  • icon Pediatric Patient Rights
    Please contact us if you have a question or concern about your child's rights or your responsibilities. We want to provide you with excellent service, including answering your questions and responding to your concerns.

  • Non Discrimination Notice

  • Non Discrimination Notice (Spanish)