Centreville Collins Avenue ,Nassau, Bahamas 242-325-1566 contact@thesurgicentre.net /

My Health Manager

Our Payment Options

The fees for your stay at The Surgi Centre can be tailored to meet your financial needs.

  • Insurance Accepted
  • Self Payment Plans welcomed
  • Salary deduction option available
Speak with your physician during your consultation, to determine the best option for you.

Please complete The Surgi Centre New Patient Form below. We would like to have your information prior to your appointment time so that we can begin to create your patient file in the office and speed up your checkin process. We greatly appreciate your help.

The SurgiCentre/The Surgical Suite- Dr. Ross Downes

REGISTRATION FORM

PATIENT INFORMATION
Patient’s last name: First :
Middle: Marital status:

Address (include P.O. Box) Email:

Chose clinic because/referred to clinic by (Please choose one option):

Please state name:
INSURANCE INFORMATION

(Please give your insurance card to the receptionist.)

Please indicate primary insurance: Colina

Atlantic Medical

BahamaHealth

Generali

Other

IN CASE OF EMERGENCY

The above information is true to the best of my knowledge. I authorize my insurance benefits be paid directly to the physician. I understand that I am financially responsible for any balance. I also authorize The SurgiCentre/The Surgical Suite- Dr. Ross Downes or insurance company to release any information required to process my claims.
Patient/Guardian signature Date m/d/y