In order to provide the best care and avoid any last-minute cancellations, we require a medical history questionnaire to be completed. This is available online for your convenience and must be completed at least 24 to 48 hours prior to your scheduled surgical date.
- Please complete all sections
- If a section does not apply, please select the check box for “No Issues”
- Be sure to include your complete medical history including current conditions, prescription and over-the-counter medications (past and present), past medical conditions/surgeries
Upon receipt, someone from our team will call you regarding your appointment.