Patient Rights & Responsibilities
View and print our patient rights and responsibilities policy.
View and print our privacy notice.
View and download our patient guide.
View and print our nondiscrimination policy.
View and print our grievance policy.
Authorization for Release of Information
View and print our release of information form.
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