 Surgery Worksheet

SURGERY INSTRUCTIONS SHEET

The Day Surgery staff will call you the day before your surgery with instructions. Complete this worksheet during that phone call.

Patient calls begin at 2pm one business day before the scheduled surgery date. This means Monday’s surgical patients are called on the Friday before. You may contact the day surgery staff at 970-384-7166 if you have not received your instructions before 5pm one business day before your surgery date.

Fill in Your Personal Instructions Below:

Date of Surgery: _____________________

Check-in Time: _____________________

*If you are late it may affect your surgery time, or result in rescheduling your surgery.*

Surgery Time:

Eating Allowed Until: __________________

*Do not eat any food after midnight before your operation unless otherwise instructed.*

Approved Clear Liquids Allowed Until: _______________

*Do not drink anything after midnight before your operation unless otherwise instructed.*

Approved Clear Liquids Include: Water, Sports Drinks, Sodas, and Strictly Black Coffee (DO NOT add milk/cream/sugar/honey).

Any Additional Eating and Drinking Instructions: _______________________

____________________________________________________________________________________ Medication Instructions: _________________________________________________________