Patient Resources


Our goal is to make your experience at MidAmerica Surgery Center as easy, comfortable and effective as possible.


Following please find the forms you'll need prior to your procedure, a list of the insurance we accept (please remember to bring your insurance card) and a look at what you can expect before, the day of and after your surgery.


If after reading the following you have any questions at all, please don't hesitate to contact us.

Patient Forms


Please click below to open a new window with your form.








Notice of Privacy Practices


Patient Bill of Rights and Patient Responsibilities


History and Physical Release


√ Pre-Op Call



Patient Satisfaction Survey



Insurance We Accept


We are providers with:

• Medicare

• Blue Cross Blue Shield

• Cigna

• United Healthcare

• Group Health Plan

• Mutiplan/PHCS

• Secure Horzions

• Healthlink


If you don't see your insurance provider listed, please contact us.

What to Expect


Preparing for Your Surgery












Prior to surgery, a nurse from MidAmerica Surgery Center will call you. The purpose of this call is to obtain a brief medical history and baseline information about your health and medication usage so that we can take better care of you. This call also gives you the opportunity to ask any questions you may have.


We will need a completed History and Physical form signed by your doctor releasing you for your procedure.


Please make arrangements for transportation home from the surgery center and for a responsible adult to be with you for 24 hours after surgery.


Please leave all money, credit cards, jewelry and valuables at home.


Notify your physician immediately if there is any change in your physical condition prior to surgery (i.e. fever, nausea, vomiting, diarrhea, or respiratory infection).


The Day of Your Surgery













Your nurse will give you instructions prior to your surgery.


Do not eat or drink anything after midnight the day of surgery (not even water) unless your physician tells you otherwise.


Do not use tobacco products, gum or hard candy the day of surgery.


Please refrain from alcohol or recreational drugs 24 hours prior to your procedure.


Please ask your physician if you should take any routine prescription medications the morning of your procedure.


Plan on arriving at the surgery center at least one hour prior to your scheduled procedure time, unless you are instructed differently, and plan on spending at least 2 hours with us.


Please leave a phone number where you can be reached the day of your procedure.


Please bring all of the paperwork you have received from your physician's offices with you on the day of your procedure.



Admission Procedures

When you arrive at MidAmerica Surgery Center, please check in at the reception desk. You will be asked to review and sign certain forms.


During the admission process, you will be asked for information regarding medical insurance coverage, including a copy of your insurance card. Identification cards such as a driver's license or government issued identification card should also be brought with you at the time of your admission.


In order to prepare your chart, you will be asked for your medical information and family history. This information enables your physician and the nursing staff to better understand your medical needs. All information given is kept strictly confidential.


Discharge Procedures

Your physician(s) will determine when you are ready to be discharged from the center. A nurse will review the discharge plans with you and your responsible caregiver at this time. We will provide a written copy of the discharge instructions which includes items such as: physical and activity restrictions, if any; information regarding medication you are to take after discharge; and other special instructions that your doctor wishes you to have. If you have any questions after your discharge, call your physician.



After Your Surgery













A nurse from the surgery center will call you at home the day following your procedure to see how you are doing. If you have a procedure on Friday you will be called the following Monday. It is important for us to know how you are feeling and progressing after your procedure

Patient Satisfaction


We know surgery can be stressful.  

That's why we work hard to make your experience at MidAmerica Surgery Center as easy and pleasant as possible.


If for any reason you weren't satisfied with your experience, please contact

our Administrator at 636.534.5101.


We'd appreciate it if you'd take a minute to complete the Satisfaction Survey below

so we can continue to improve our service.


Thank you for choosing MidAmerica Surgery Center.


Satisfaction Survey

Surgery center ambulatory

© 2019 MidAmerica Surgery Center, LLC. All rights reserved.

1815 Clarkson Road • Chesterfield, MO 63017

636.534.5101 • 636.534.5059 (fax)