Please fill out the secure patient information form below to the best of your ability. GulfCoast Surgery Center prioritizes patient saftey when performing outpatient procedures. Your honesty in answering these questions is directly linked to your health and safety at GulfCoast Surgery Center. Your information will be securely sent to our administrative office for review. For security purposes, patients cannot save any information from the form page, and information will be erased if not completed and submitted.