The Surgery Center of Huntsville

Your medical facility must know your health information and medical history prior to your procedure. Filling out the online form is easy, secure, and essential for you to receive the best care possible.

It's a simple process…

Please be forthcoming with your responses. All of your medical information is confidential.

  • The time it takes to complete the form is dependent on your personal medical history. Typically, a person who is healthy and not taking many medications should expect to spend 15 minutes completing the form. Someone with a more complicated medical history or list of medications will take longer.
  • Upon receipt of your information, a staff member or nurse may call you for further clarification if necessary.

NOTE – You do NOT need to submit a form if you have been a patient at The Surgery Center within the last 30 days and have already completed an online form.  If it has been longer than 30 days since you were a patient at The Surgery Center or you have had changes in your medications or medical history since you were in, please complete a new form,or call 256-532-9505 ext 439 to contact a pre admission nurse to update and review your history.

What will I need?

Before you begin the online admissions form, please make sure that you have the following information available, as it may be needed to complete your form:

  • Prescription medicationsnames and dosage of each one you take.
  • Over-the-counter medicationnames and dosage of each one you take regularly.
  • Vitamin and herbal medications - names and dosage of any that you take.
  • Allergies/Sensitivities you have, and the allergic reaction(s) they cause.
  • Previous surgeries, and the year they were performed.
  • Medical Insuranceinsurance company, policy number, ID number, etc.

For new patients, or if you wish to start a new form, please enter the password that was provided to you by your medical facility:
- OR -
If you'd like to resume, modify, or review an existing form please enter the secured access token provided by the Surgery Center and your date of birth.
The access token should have been sent to you by email, or given to you by a member of the medical staff.
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© Simple Admit Management 2017
1.9.2016.819 (08.19.2016)