A nurse from the center will contact you with preoperative instructions.  If you have not spoken to a nurse from the center and it is the day prior to your procedure, please call 904-823-1447 between 8 a.m. and 5:00 p.m.  If you have any questions and are unable to reach the center, please call your physician office.

Procedure time: _______ Arrival time: ________
PLEASE plan to arrive as close as possible to the arrival time. Spoke with: _________________________

FOR YOUR SAFETY AND THE SAFETY OF OTHERS, YOU MUST HAVE A RESPONSIBLE ADULT TO DRIVE YOU HOME AND STAY WITH YOU FOR 24 HOURS FOLLOWING SURGERY. Failure to comply with this WILL result in cancellation of your procedure. Who will be with you? ___________________________________________________________

General Instructions · Please be sure to follow the pre-op testing guidelines that you will receive at your Physician’s office. · Bring insurance cards and driver’s license. · Wear loose fitting, comfortable clothing. Button down shirts are best. Wear warm socks. · Remove all jewelry and metal. Any piercing must be removed. Leave valuables at home. · Bring your glasses to read and sign paperwork. · Bring ONLY one person with you, and have them dress warmly and/or bring a sweater. We prefer for this person to remain on premises while you are having your procedure. · AVOID alcoholic beverages for 24 hours before and after surgery. · SMOKERS should refrain from smoking after midnight the night before surgery. · Notify your doctor is you develop any signs of illness, sore throat, fever, infection, difficulty breathing, or chest pain prior to your procedure.   Eating Instructions · You should have nothing to eat after 12 midnight. You may drink clear liquids up to 6 hours before surgery. These include water, apple juice, fruit juice without pulp, clear soda, black coffee, or hot tea – no milk or sugar added. · You should not chew gum or eat candy including hard candy or breath mints. Other: _________________________________________________________________ Following these instructions reduces the possibility of nausea and vomiting during and following your procedure. Failure to follow these can result in the cancellation of your procedure. Medications Instructions · Do not take insulin, oral diabetic medications and/or diuretics the morning of surgery. Call your family physician regarding instructions for insulin or anticoagulant therapy and follow their instructions. · All other blood pressure, cardiac, respiratory, and seizure medications should be taken per your normal routine the morning of surgery with a sip of water. Please note the time. · Discontinue the use of all herbal products two weeks prior to your surgery.   Hygiene · You may want to bathe or shower before your procedure. In many cases you may not be able to bathe immediately after surgery. Do not use oils, perfume, after,-shave, body lotion, powder, or make-up. You may use deodorant. · You may brush your teeth and gargle, just remember not to swallow any water.   Pediatric Patient · Patients under 18 must be accompanied by parent/guardian. · Parent/guardian must remain in the building. · If your child is having a procedure, bring their favorite toy and sipper cup. · Breast milk may be consumed up to 3 hours before surgery. · Infant formula may be consumed up to 6 hours before surgery.

Date: _________ Time: _________

Completed by: ______________________________ PATIENT LABEL