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Ambulatory Surgical Centers Application Package

The applications package for the Ambulatory Surgical Center must include all documents listed in the chart below. The Department reviews each application package and determines an applicant's eligibility for a license.

Specific instructions are provided within each form below.

Application Forms

Ambulatory Surgical Center Licensure Application Form [PDF]

Application Information Documents

DC Ownership and Disclosure Form [PDF]
Clean Hands Act of 1996 Certification Form [PDF]

Contact Phone: 
(877) 672-2174
Contact Fax: 
(202) 727-8471
Contact TTY: 
711
Contact Suite #: 
2nd Floor
Office Hours: 
Monday to Friday 8:15 am to 4:45 pm
Service Location: 

899 North Capitol Street, NE

GIS Address: 
899 North Capitol Street, NE
City: 
Washington
State: 
DC
Zip: 
20002