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.
This tool is part of the industry-leading, advanced technology system implementing HIPAA security for your information.
• 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.
• List of all medications
• List of allergies and sensitivities
• Name and date of previous surgeries
• Your medical history