Pre-op screening patient form (pdf) - Le Bonheur Children 's Hospital - lebonheur 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the date of surgery and the surgeon’s name at the top of the form. Ensure these details are accurate as they are crucial for your child's procedure.
3. In the Patient Information section, fill in your child’s name, date of birth, age, and contact numbers. Be sure to include all relevant phone numbers for easy communication.
4. Answer all medical history questions thoroughly. If a question does not apply, write 'N.A.' to indicate that it is not relevant.
5. For anesthesia information, provide details about any previous surgeries or complications. This section is vital for ensuring your child's safety during anesthesia.
6. Complete the medication and allergy sections carefully. List all medications your child is currently taking and any known allergies to ensure proper care.
7. Once completed, review the form for accuracy before submitting it as instructed. The surgeon's office will fax this completed form after you finish.

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