Surgery Scheduling Form

Here is the Surgery Scheduling Form for Main Surgery and the Outpatient Surgery Center (OSC). This form is an active PDF that can be filled out electronically. You can simply tab through the form, populating each piece of required information. The form automatically formats text so that lengthy procedures and multiple equipment requests will easily fit on the form and remain legible.

When finished entering information, simply print out the completed form, sign and fax.

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

SJS-RS-SurgeryScheduling@hshs.org

Fax: (217) 757-6018

Thank you,
St. John’s Surgery Department