Patient Checklist, Medication List And Anesthesia Questionnaire

Patient Checklist

Please use this as a tool to expedite the check-in process.

On Surgery Day:

 DO NOT eat or drink anything after midnight, the night before your

procedure unless you have been instructed otherwise.

 You will need a responsible adult to provide transportation home

and care after your procedure.

 Wear comfortable, loose fitting clothing.

 Bring cases for eyeglasses, contact lens and dentures.

 Bring medical insurance cards, a picture ID and appropriate co-payment

amount.

 Bring any x-rays, slings, crutches, ice machine or any other supplies

our physician has provided.

 Bring the completed Medication list. – see attached form

 Bring the completed Anesthesia questionnaire. – see attached form

 Please leave all jewelry and valuables at home.

 Remove all body piercing before coming to the Center for Surgery.

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Parent category: Life