Siouxland Surgery

Guest Preferences

Guest Preferences

Guest PreferencesIf you are planning a stay with us, you can request some amenities that will make your stay more comfortable. Also, providing us with the additional information in the form below will expedite your registration process.

We invite you to bring your own pillow, or other items to provide a more comfortable experience.

If you have any questions, please call us at: (605) 232-3332

 

Country Inn & Suites at Dakota Dunes

Country Inn & SuitesIf you prefer to stay in a hotel during your visit, or need a place for friends and family to stay, consider Country Inn & Suites at Dakota Dunes. Convieniently located right next door, Country Inn & Suites at Dakota Dunes and Siouxland Surgery Center have negotiated a special room rate for patients. This special rate is only available for Siouxland Surgery Center patients and associates.

For more information on room rates, please visit http://www.countryinns.com/siouxlandsurg or call (605) 232-3500.

 

req = Required Field


Guest Preferences Form

Patient Information:

req Email Address:

req First Name:

req Last Name:

Name of Support Person:

Where Staying Before Surgery:

Home Phone Number:

Work Phone Number:

req Family Physician Name:

Status Post-op:

Outpatient:

Overnight:

 

 

Patient Preferences:

Beverages:

Snack (appropriate to surgery):

Reading Material (magazines, newspapers):

Bedtime Snack (Overnight only):

Other Requests or Special Needs:


 

Support Person Preferences:

Beverages:

Snack (appropriate to surgery):

Reading Material (magazines, newspapers):

Bedtime Snack (Overnight only):

Other Requests or Special Needs: