Patient Information

Welcome to the Southwest Surgical Suites Patient Information portal! You’ll likely have questions before, during, and after your procedure. Here you will find all the details, from what to wear to what to avoid in the hours leading up to your visit, all part of our goal of making you as relaxed and comfortable as possible.


These forms are required for your upcoming procedure. Please download, print, and fill out these forms, and mail them to our office 1 week before your procedure. This will help expedite the patient intake procedure and give you more time to completely fill out the information.

Patient History (PDF)
Medications (PDF)

The following forms are for your information only and do not need to be printed or returned:

Patient Rights (PDF)
Advance Directives (PDF)


Payment and Insurance

Patient Billing and Payment Information (PDF)

At Southwest Surgical Suites, we do everything we can to make your payment or billing process easy and as smooth as possible.


Good Faith Estimate

A patient may ask for an estimate of the amount he/she will be charged for a non-emergency medical service provided in this facility. The law requires that an estimate be provided within five business days of the request.

  • Fees charged by Southwest Surgical Suites are in addition to your surgeon and/or anesthesia provider fees.
  • You may be contacted by a Patient Accounts Representative before your surgery to go over any relevant insurance information and to answer any questions you may have.
  • The Patient Accounts Representative can help obtain approval or pre-certification for your procedure, if necessary

If you do not have insurance or are paying cash for your surgery, you will be asked to submit payment on or before the date of your surgery, unless other arrangements have been made. You may also be asked to sign a financial agreement. Please remember that these arrangements are your responsibility and must be made prior to your surgery.

  • If you have verified insurance, you will be asked to pay only your portion (your co-payment and/or deductible) on or before the day of surgery.
  • We accept all major credit cards.
  • We will bill your insurance provider for you. Any balance that your insurance provider does not cover is your responsibility.
  • Hours 9:00 a.m. - 4:30 p.m., Tuesday - Friday.
  • If you have questions about your bill or nee to discuss special financial arrangements, please contact our office at 260-434-2022.

“Carolyn has had twenty surgeries over the years. She has been in facilities all over the Midwest. By the way we scored your facility, Southwest could teach a whole lot of facilities and healthcare professionals how to treat and care for patients. Thank you for your courtesy.”

James and Carolyn