Print this form and fill in the information if your doctor recommends that you have a surgical procedure.
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What is the name of the surgical procedure? |
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Why do I need surgery? |
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How soon should surgery take place? |
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What might happen if I delay or avoid the surgery? |
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What results should I expect from the surgery? |
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Are there any nonsurgical options? Yes ___ No___ If yes, describe: Are there any less invasive surgery options? |
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What is the next step if this surgery doesn't work? |
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How much does the surgery cost? How can I find out? |
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Can it be done on an outpatient basis, and is that less expensive? |
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What kind of preparation is needed for surgery? |
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Where will surgery be done?
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How is the surgery done (laparoscopy or open surgery)? |
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What kind of anesthesia will be used (general, local, or regional)? |
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How long will the procedure take? |
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How successful is this procedure? |
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What are the risks associated with this surgery? |
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How much experience does the surgeon have with this procedure? |
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Has the procedure been done often in this hospital or surgery center? Yes ___ No___ |
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What complications might develop (both immediate and long-term)? |
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If a biopsy is being done, when can I expect to hear the results, and will my doctor call me? |
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Other questions: |
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How long will I have to stay after surgery? |
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How will I feel after surgery? |
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How much pain is there after this type of surgery? How is it treated? |
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How long will it take to recover from surgery? |
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Other questions: |
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What kind of care will I need at home? Are there any activity limitations? |
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How soon can I eat a regular meal? |
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How soon can I resume regular activities? |
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What symptoms should I watch for and report? |
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Other questions: |
Current as of: October 6, 2021
Author: Healthwise Staff
Medical Review:Anne C. Poinier MD - Internal Medicine & Adam Husney MD - Family Medicine & Kenneth Bark MD - General Surgery, Colon and Rectal Surgery
This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. Learn how we develop our content.
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