Our Mission:


To provide the patient community with a premier medical facility that is conveniently located and offers a comfortable and safe surgical and recovery environment.



Patient Forms



All Patient Forms are in PDF format and require Adobe Acrobat Reader to view or print. If you do not have

Adobe Reader installed on your computer, you can get it free by clicking here.



Click on any form to view:



Online Pre-Registration


HIPAA Notice of Privacy Practices


HIPAA Notice of Privacy Practices (en Espanol)


Patient Rights and Responsibilities


Patient Rights and Responsibilities (en Espanol)


Advanced Directive


Advanced Directive - Living Will


Please Take Our Patient Satisfaction Survey





Bergenfield Surgical Center, LLC

1 North Washington Avenue, Suite A

Bergenfield, NJ 07621



© 2014 Bergenfield Surgical Center, LLC