Forms & Policies

These forms are intended to allow Valley Ambulatory Surgery Center to provide health care services to as many patients as possible in a timely manner. Please download the form, fill it out, and mail it back to VASC at the following address.

Valley Ambulatory Surgery Center
Patient Representative
2210 Dean Street
St. Charles, IL  60175

Forms & Policies Download:

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• Insurance Information for Patients
• Patient History Form
• Insurance Verification Form
• Special Patient Information/Patient Rights
• Informacion Especial Al Paciente – Derechos Del Paciente
• Pediatric Version of History Form
• Interventional Pain Clinic Form