Outpatient Surgery Anesthesia CHECKLIST

 

Anesthesia Consent Form 

•  Please read carefully, complete, and sign (all areas shaded in gray on pages 3 and 4 MUST be completed and signed).

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Telephone Anesthesia Consultation​

• Monday 6:00 PM – 8:00 PM

• Tuesday/Thursday 2:00 PM – 4:00 PM

• Alternatively, please leave a message, and we will call you back prior to your surgery. (Return calls are not always made on the same day)

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Fasting Rules before Surgery

• 6 hours: Nothing to eat, no smoking, no milk, no chewing gum, no candy, etc.

• Up to 2 hours before the surgery (OP): A little still water may be consumed.

• 2 hours: Nothing to drink.

 

Accompanying person​​

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Bring the health insurance card, this form, and relevant findings (or "relevant medical reports/documents")