Pre-procedure checklist

Patients confirm fasting, medication, transport and consent items the day before a procedure.

About 3 min to complete. pre-op, procedure, checklist, patient.

Questions in this template

1. Patient name
2. I have followed the fasting instructions I was given
3. I have taken only the medicines I was told to take
4. An adult will take me home afterwards
5. Has anything about your health changed since your last visit?
6. Consent

Related templates

• Patient intake
• Appointment request
• Weekly wellness check-in
• Dental new patient form