Rockford Ambulatory Surgery Center Interior

Patient Resources

Patient Guide

Your preparation and cooperation are important in the safety, success and recovery from surgery.

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Patient Satifaction Survey

At RASC, we value your feedback! Please take a moment to fill out our brief questionnaire so that we may continue to improve our services. All submissions are strictly confidential. Thank you!

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Patient Rights & Responsibilities

View and print our patient rights and responsibilities policy.

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Privacy Notice

View and print our privacy notice.

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Nondiscrimination Notice

View and print our nondiscrimination policy.

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Grievance Policy

View and print our grievance policy.

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Authorization for Release of Information

View and print our release of information form.

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Complete the ROI form and return to Rockford Ambulatory Surgery Center by mailing it or faxing it to our Medical Record Department. You may also bring the form into our offices.

Medical Record Department
Rockford Ambulatory Surgery Center
1016 Featherstone Rd.
Rockford, IL 61107

Telephone: 815-226-3300
Fax: 815-226-9990

Surprise Billing Disclosure

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing. Read about your Rights and Protections Against Surprise Medical Bills.

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