Your pre-operative responsibilities

1. Make sure that you understand your diagnosis. Ask me all your questions. Keep a list of all questions that come up after the visit and use that list at our next visit.
2. Make sure that you understand the procedure I recommend: the benefits and likelihood of achieving them, the risks of complications and likelihood of them occurring, and the alternatives to surgery. I will tell you this information before surgery at your final pre-operative visit, but before you sign your consents, make sure that I have answered all your questions to your satisfaction.
3. Read all of the handouts that I have given you. Be ready to ask your questions that develop from reading your handouts. Know how your recovery at home will proceed.
4. Have your spouse, partner or friend who is assisting you during your post-operative recovery read this entire handout so that they can help you in the hospital and after you are discharged.

Name of the person who has read this handout and will be helping you:

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5. List all medications, including non-prescriptive over-the-counter drugs, herbs, supplements, vitamins, and please give precise doses of each:

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6. State all allergies/sensitivities to medicines and effects:     __No allergies.

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7. Give the names of your current physicians, address, phone and fax numbers so I can keep them well informed about you.

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8. Commit to your own health: start exercising and healthy eating well before surgery.

9. With my signature below, I certify that I have read the handouts given to me, and that I understand my diagnosis and the procedure planned. I understand the instructions and will follow them or I will call Dr. O’Hanlan for clarification.

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Signature

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Print name

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Date

Link to PDF of Pre-Op Agreement