Pre-Surgery Checklist

You will need to complete the following specialist visits prior to procedure approval:

☐ Clinic visits (number dependent on your preparation for surgery and insurance requirements)

☐ 2 to 5 Nutrition visits

☐ Psychiatric Evaluation

☐ Physical Therapy Evaluation

☐ Sleep Apnea Screen and additional testing (sleep study, titration study)

☐ Liver Ultrasound

☐ Upper GI (special X-ray of esophagus and stomach while drinking with oral contrast)

☐ EGD (Upper endoscopy)

☐ EKG (Electrocardiogram, to check your heart)

☐ Labs

☐ Additional required surgery clearances as needed based on your health conditions

Notes & scheduled procedures:

Discuss any medication changes with your prescribing physician well before your surgery is scheduled.

Initially, all oral medications must be taken one at a time, and must be broken in half, crushed, or opened if any larger than a baby aspirin. Some extended release or psychiatric medications cannot be crushed, so please discuss with your prescribing physician. They may need to prescribe a liquid or other alternative medication.

Pregnancy: Women should not become pregnant for 18 months post-surgery. Use 2 forms of birth control during this time unless you have an implantable form of birth control. Please contact us with questions.

If you take medications for diabetes:

• Follow all recommendations from your endocrinologist and/or primary care physician

• Monitor your blood glucose at home using a glucometer (glucometer must be available prior to surgery).

If you take medications for hypertension:

• Follow all recommendations from your cardiologist and/or primary care physician

• Monitor your blood pressure at home at least 2 times a day (in the morning and evening).