Surgery Block Time Release Form

Here is the Surgery Block Time Release Form for Main Surgery and the Outpatient Surgery Center (OSC).

This form is an active PDF that can be filled out electronically. However, to send the form back electronically you must use Internet Explorer.

You may also fill out the form electronically, print it and email or fax it back to Surgery Scheduling.

If you have questions, please call the surgery director at (217) 544-6464, ext. 51658.

SJS-RS-SurgeryScheduling@hshs.org

Fax: (217) 757-6018