Forms to Complete Prior to Surgery

Preoperative Medical History Questionnaire

Medical history: It is absolutely necessary that the entire team of providers that will be seeing you before and during surgery know your medical history. While we have access to your information in our computer database and in your chart, please understand that we want to confirm your most up to date medical status. Therefore, we ask that you complete a Preoperative Medical History Questionnaire that includes information such as your illnesses and past illnesses, any medications or dietary supplements that you take and the doses, any allergies that you may have, any prior surgeries that you have had, whether you smoke and how much, whether you drink and how much, and whether you use any illegal drugs – bring it to all of your preoperative visits. You will no doubt be asked numerous times about things such as your medications and your allergies by the many providers that compose the surgical team that will care for you – please bear with us, as we are trying to insure your absolute safety.

We prefer that you complete and submit the Preoperative Medical History Questionnaire online 48 hours or more before your preoperative appointment. Your form will be securely uploaded into your electronic medical record, so that we can review it before your visit with us. If you are unable to complete the form online, please print a hardcopy form, complete it prior to your preoperative visit, and bring it with you to your appointment.

Surgical Admissions Questionnaire

Please fill out a Surgical Admissions Questionnaire, which is immediately faxed to the Admissions office, before coming to your scheduled surgery. This form asks you about your wishes during your stay in the hospital and your emergency contacts. Again, we want to make sure we have all of the updated information for you as we know these things change often. If you forget to fill out this form in advance, you can fill out a paper copy in the waiting room when you arrive.