Pre-Operative Education Class

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KC Bariatric, LLCPre-Operative Education Class Session

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Full Name* This field is required.

First Name

Last Name

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Parent/Guardian Name (if applicable)

First Name

Last Name

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Date of BirthPatient's date of birth

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Email Address

you@example.com

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Surgery:* This field is required.What surgery are you seeking?

Roux-en-Y Gastric Bypass

Sleeve Gastrectomy

Revision

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Surgeon:* This field is required.Who is your surgeon?

Dr. Stanley Hoehn

Dr. Brice Hamilton

Dr. Robert Aragon

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Today's Date* This field is required.

Date

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PRE-OP EDUCATION CLASS

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If you have any questions regarding the topics discussed in this class please contact:

Katie Hiller, BSN RN

913-676-8492

katie.hiller@AdventHealth.com

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Please mark below topics reviewed in this educational session.* This field is required.

Plan of care during hospitalization

Pre and post operative guidelines

Surgical procedure

Potential complications and how to prevent them

Need to stop smoking at least 6 weeks prior to surgery to prevent ulcers

Need for lifestyle changes after surgery and importance of support groups

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Patient Signature