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Shawnee Mission Surgery Center

   Surgery Center Patient Pre-Registration

Get Directions: Shawnee Mission Surgery Center at Shawnee Mission Medical Center
or call 913-632-9300.

Other Helpful numbers:

Pre-Surgery Department: 913-632-9333
Co-payments or co-insurance questions: 913-632-2324
Billing questions, or to make a payment on your account: 913-676-7769
Technical problems with your online pre-registration: 913-676-2062

Get Directions: Shawnee Mission Surgery Center at Prairie Star


Surgery Pre-Registration

General Information

Patient Information

Emergency Contacts

Name of responsible adult with you day of surgery (if having anesthesia)
Is it OK to share any medical information and/or home instructions with this person?

Medical Information

List any surgeries/major illnesses (including cancer) you have had and approximate date
Have you or a blood relative ever had a complication/reaction from anesthesia?
(fever, malignant hyperthermia, difficulty awakening, nausea, airway complications)
List any ALLERGIES to medications, iodine/contrast dye, latex, tape or food. Include reaction.
List the medications you are currently taking, the dose and time of day you take them.
Check if you have ever had any of the following:

Are you in an abusive situation or do you lack support?

Women Only

  • If you have hit submit, and you do not get a thank you screen, your registration did not go through. Scroll up to see if there are required fields that were not completed.
  • You will see a thank you message and receive a confirmation email if your registration was submitted successfully.
* Required
Shawnee Mission Medical Center
9100 West 74th Street
Shawnee Mission, Kansas 66204
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Prairie Star
23401 Prairie Star Parkway
Lenexa, Kansas 66227
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