Portfolio Category: Forms Attached

Consent Form

FINANCIAL INFORMATION CHARGES: Charges for Gateway Surgery Center and your Physician are separate. The facility (Gateway Surgery Center) charges include the use of the operating / procedure room, nursing staff, medications and most supplies. Your surgeon, anesthesiologist, certified nurse anesthetist, radiologist and pathologist (if applicable) will bill you separately for their services. CONTACTING OUR INSURANCE…
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Advance Directive / Patient Rights

Medical Care Decisions and Advanced Directives: WHO DECIDES ABOUT MY MEDICAL CARE OR TREATMENT?: Read full article for more. WHAT IS AN ADVANCED DIRECTIVE?: Read full article for more. DO I HAVE TO HAVE AN ADVANCE DIRECTIVE AND WHAT IF I DON’T?: Read full article for more. LIVING WILL ~ WHAT IS A LIVING WILL?:…
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Patient Packet

Welcome! Gateway Surgery Center is pleased with the decision you and your physician have made to utilize our facility. We want to make your upcoming visit as comfortable and pleasant as possible. Our Center was founded to provide patients and physicians with the finest quality health care at an affordable cost. We provide excellent care…
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Joint Ownership

Our physicians have an ownership interest in Gateway Surgery Center, along with CMC-Northeast Medical Center (CMC-NE). This means that the fee for the use of this facility may go to these investors. All of these physicians are members of the staff of CMC-Northeast Medical Center located nearby. You have the right to choose to have…
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Insurance

Insurance and Billing informationGateway is contracted with most insurance companies; however, you may want to contact your insurance to find out if you need authorization prior to services. The facility files for reimbursement from the patient’s insurance company as a courtesy, and all services rendered are the financial obligation of the patient, or guarantor. We…
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Make a Payment / Pay my Bill

You may now make a payment online by using this secure link. Please contact our business office at 704-920-7045 with any questions or to setup an established payment plan.  
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Taglines Top 15 Languages

Assistance Services Translation Tagline Informing Individuals With Limited English Proficiency of Language ATTENTION: If you speak__________, language assistance services, free of charge, are available to you. Call 1-800-945-7889(TTY: 1-800-735-8262).  
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