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Surgery Scheduling Block Request Form

Here is the Surgery Scheduling Block Request Form for Main Surgery, Outpatient Surgery Center (OSC) and the GI lab.

This form is an active PDF that can be filled out electronically. Please return the completed form to Charish Gibson and Luke Straus. 

If you have questions, please call the surgery director at (217) 544-6464, ext. 51658.

Fax: (217) 757-6018