Geneva Surgical Suites, LLC
  • Home
  • About Us
    • Take a Tour
  • Patient Forms
  • Pay a Bill Online
  • Physicians
    • Marc Angerame, MD
    • Samir Baig, MD, MPH
    • Harpreet S. Basran, MD
    • Gregory T. Brebach, MD, SC
    • Craig A. Cummins, MD, SC
    • Gregory Drake, DO
    • Justin Gent, MD
    • Daniel Kuesis, MD
    • Raymond Metz, Jr., MD
    • Jeffrey Murray, MD
    • Jeremy M. Oryhon, MD, SC
    • Priyesh Patel, MD
  • Careers
  • Contact Us
  • Accommodations
  • Testimonials
  • Blog

Patient Forms

Assignment of Benefits

assignment_of_benefits.pdf
File Size: 285 kb
File Type: pdf
Download File

Declaration to Physicians Living Will Form

declaration-to-physicians-living-will-form.pdf
File Size: 140 kb
File Type: pdf
Download File

WI Advance Directives Statutes

wi-advance-directives-statutes.pdf
File Size: 135 kb
File Type: pdf
Download File

Power of Attorney for Health Care Form

power-of-attorney-for-health-care-form.pdf
File Size: 276 kb
File Type: pdf
Download File

Notice of Privacy Practice

Disclosure Notice of Patient Rights & Protection Against Surprise Billing

hippa_form.pdf
File Size: 108 kb
File Type: pdf
Download File

​disclosure_notice_no_surprises_act.pdf
no_surprise_act_fact_sheet.pdf​

​Things to Know Before You Go

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119 Elizabeth Lane 
Genoa City, Wisconsin 53128
​P: 262.295.1213
​F: 262.295.1221
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  • Home
  • About Us
    • Take a Tour
  • Patient Forms
  • Pay a Bill Online
  • Physicians
    • Marc Angerame, MD
    • Samir Baig, MD, MPH
    • Harpreet S. Basran, MD
    • Gregory T. Brebach, MD, SC
    • Craig A. Cummins, MD, SC
    • Gregory Drake, DO
    • Justin Gent, MD
    • Daniel Kuesis, MD
    • Raymond Metz, Jr., MD
    • Jeffrey Murray, MD
    • Jeremy M. Oryhon, MD, SC
    • Priyesh Patel, MD
  • Careers
  • Contact Us
  • Accommodations
  • Testimonials
  • Blog