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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Patient Guide

View and download our patient guide.

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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