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