Tuesday - Friday: 6:00 AM - 5:00 PM

Patient Information

Medical History & Nursing Agreement

Please use www.OneMedicalPassport.com to complete (fill-out) your medical history form as soon as possible. You will receive a phone call from an RN (2-5) days prior to your surgery and/or procedure date.

Please make sure we have a daytime phone number (Cell phone, if possible) where you can be reached.

Required Testing Order Form

Contact your family physician if you require lab work or an EKG.
Labs good for 30 days before surgery date. EKG good for 6 months before surgery date.
Note: All females ages 12-55 years with a uterus will have a pregnancy test day of surgery.

Surgery Arrival Time

Please call 609-265-7800 the day before your procedure/surgery between the hours of 2:00 PM – 4:00 PM for your arrival time at the Memorial Ambulatory Surgery Center. Please call Friday if you are having surgery on Tuesday.


If you are taking blood thinners, aspirin, ibuprofen, motrin, advil, aleve, diet pills or herbal supplements, call your surgeon and/or physician for further instructions. Discontinue diet or herbal supplements two (2) weeks prior to surgery and/or procedure.

Dietary Restrictions

Do not eat or drink anything after midnight the night before your surgery, unless otherwise instructed by the pre-admission nurse.

Financial Arrangements

On surgical and/or procedural day bring the following

  • Referrals
  • Insurance Cards
  • Form of photo identification
  • Co-Pay (due day of surgery/procedure)
  • Payment Methods: Cash, Personal Check, Money Orders, Certified Check, VISA, MasterCard, or Discover Card.
  • Contact Business Office at 609-265-7800 to discuss, if any, financial arrangements prior to surgery

Please take notice that the Facility bills under Virtua Health System’s insurance contracts and is considered in network with any contract Virtua Health System participates. If you have another carrier the facility may not be a participating provider with your insurance carrier and your upcoming procedure   will be considered “out-of-network”.  In either case you will be personally responsible for the co-payment, co-insurance, deductible, or other charges associated with your care for any services that are not covered by your insurance carrier.  It is important that you contact your insurance company directly to obtain more information on your plan coverage and out-of-pocket costs

General Information
  • If you develop a fever, cold, flu or any change in your condition 5 days prior to planned surgery and/or procedure, contact your surgeon.
  • Make arrangements for someone (no cab or bus drivers) to drive you home after your surgery and/or procedure. Your driver should remain in the building until you are ready for discharge. A responsible adult must stay with you after surgery.
  • Do wear comfortable clothing
  • Do not wear make-up, jewelry (including wedding rings), cologne, or contact lenses. All body jewelry (including piercings) must be removed at home prior to surgery/procedure date.
  • Do not bring valuables.
  • Failure to adhere to any of these instructions may result in cancellation of your procedure.
  • You will receive written discharge instructions.
  • Free Wi-Fi access available in our lobby.
Pathology Groups

Diagnostic Pathology Consultants
175 Madison Ave., Mt. Holly, NJ 08060
Billing Office: 855-294-9520

Virtua Lab (Technical)
100 Bowman Drive, Voorhees, NJ 08043

Anesthesia Groups

Burlington Anesthesia Associates, PA
120 Madison Avenue, Suite E, P.O. Box 174, Mount Holly, NJ 08060
Lana Gordover: 609-261-1660

Our goal is to provide you with an excellent patient care experience.