Center for Surgical Excellence Inc.

DISCLOSURE OF PHYSICIAN OWNERSHIP

Please carefully review the information in this notice.

1.     Center for Surgical Excellence Inc. meets the definition of a “physician-owned hospital/Ambulatory Surgery Center” under 42 CFR. The Surgery Center is owned in part by the following physicians:

Dr. Raoul Joubran

Dr. David Beck

Dr. Jeff Fowler

Dr. Todd Hammond

2.    You have the right to choose the provider of your health care services.  Although we believe that Center for Surgical Excellence Inc.  will be able to meet your needs, you have the option to use a facility other than the Center for Surgical Excellence Inc..  You will not be treated differently by your physician if you choose to use a different facility; however, your physician may not be able to perform your procedures at an alternative facility, if he or she does not maintain privileges at such facility.  If desired, your physician or any staff member can provide information about alternative health care providers.

3.    Please be aware a physician is not always on premises.

If you have any questions concerning this notice, please feel free to ask your physician or any representative of the Center for Surgical Excellence Inc.

We welcome you as a patient and value our relationship with you.

Thank you for choosing our facility for your care.