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Click ‘Get Form’ to open the Patient Pre-Admittance Questionnaire in the editor.
Begin by entering your name and date of birth at the top of the form. This information is essential for identification purposes.
Fill in the date of your procedure, phone number, height, and weight. Accurate details help ensure proper care.
In the proposed procedure section, list the surgery you will undergo along with your surgeon's name and family doctor’s contact information.
Answer all medical history questions thoroughly, including allergies, medications, and previous surgeries. Use checkboxes where applicable for clarity.
Sign and date the form at the bottom to confirm that all information provided is accurate before submitting it to your physician’s office.

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What level trauma center is Hartford Hospital?

Hartford Hospital is the regions first Level 1 Trauma Center, and operate the states first air ambulance system, LIFE STAR.

What is the crime rate in West Hartford CT?

West Hartford, CT has a slightly higher overall crime rate (34.27) compared to the national average (33.37), but its violent crime rate (3.39) is docHubly lower than the national average (13.84).

What does Hartford Hospital specialize in?

The hospitals major centers of clinical excellence include cardiology, oncology, emergency services and trauma, mental health, womens health, orthopaedics, bloodless surgery and advanced organ transplantation.

Is it better to have surgery at a Hospital or surgery center?

For patients who are eligible for outpatient surgery, surgery centers can offer a high quality, lower-cost alternative to hospitals. However, complicated cases and procedures that require greater recovery and observation times are better suited for hospitals.

How is a surgery center different from a hospital?

Ambulatory surgery centers are offsite facilities, meaning separate from hospitals. Surgery centers are typically owned and managed by a private entity or group of health care providers. Ambulatory surgery centers are often more efficient with no differences in procedural complication rates vs.