Patient Name

• DISCHARGE FROM OFFICE

  • The patient must be discharged into the care of a responsible adult who can accompany him/her home.
  • Arrangements should be made to have a responsible adult remain with the patient for the balance of the day and during the night.
  I understand.

• TRANSPORTATION FROM OFFICE

  • Private automobile is preferred.
  I understand.

• FOOD AND BEVERAGES

  • Clear liquids are advised initially and, after that, diet as tolerated.
  • Do not drink alcohol in any form for 24 hours.
  • No marijuana use for 48 hours (smoking, edible, or oils).
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• MEDICATIONS

  • Resume normal medication as directed by physician after appointment.
  I understand.

• ACTIVITY RESTRICTIONS

  • Do not operate motor vehicles, boats, power tools or machinery for 24 hours, or longer if drowsiness or dizziness persists.
  • Do not operate an aircraft for at least 48 hours following minimal or moderate sedation.
  • Do not sign or enter into any legal contract for at least 24 hours.
  • The law considers the patient to be impaired for 24 hours following sedation.
  I understand.

• PROBLEMS

  • If you experience any acute pain, heavy bleeding from the surgical site, respiratory problems, or any other post-operative problem of concern, call: 403-263-9014. If you have an after-hours emergency, please listen to the voicemail message for instructions.
  I understand.