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Patient pre-registration form

Fields marked with an asterisk (*) are required.

Primary insurance plan

Secondary insurance plan

Our Surgery Center is operated under Oswego Hospital and is billed as an outpatient hospital facility. Please contact your insurance plan for coverage and benefits for your scheduled procedure.

Please be advised that you may receive multiple bills for your service. In addition to the hospital services you may receive a bill for anesthesiology, pathology, radiology and your surgeon. You can find the list of our contracted physicians on our website.