Indio Surgery Center
Your child's Comfort & Safety is our #1 priority.
Call (760) 396-5733

Patient Forms

Below you will find a complete list of forms that will be required in order to provide treatment. All forms are downloadable in PDF format; please print and complete.

Patient Information Form 

Medical Clearance Form

Authorization for Release of Information

Pre-Anesthesia Questionnaire

Latex Allergy Questionnaire

ISC Financial Policy

Dear Parent

Notice of Privacy Practices

On the day of surgery, please bring Guardian Photo Identification and Dental and Medical Insurance Cards.

If you have any questions, please feel free to contact us at (760) 396-5733 or email us at

This web site uses files in Adobe Acrobat Portable Document Format (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.



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