Patient Registration

Confidential Patient Information

Financial Party Information

Insurance Information

Medical History

Allergies or drug reaction to:

All answers default to NO. Please select YES if the patient has had any of the conditions listed below either now or in the past.

Wisconsin Surgery Center, located at 3305 South 20th Street, Suite 150, Milwaukee, WI 53215 is a technologically advanced surgery center for general surgery, gynecologic surgery, orthopedics and pain management procedures, among many others.
Call 414-384-2100 or fax to 414-384-2700.

facebook twitter youtube