Pre-Surgery Health Screening Form

Before you begin, be sure to have all of the information listed below:

• Name of doctor doing your surgery/procedure
• Date of scheduled surgery/procedure
• Name of the person who will be driving you home after your procedure
• Name of the person who will care for you once you return to your home
• Name and dosage of ALL medications
• Dates and descriptions of all previous surgeries/procedures

If you would prefer not to submit your health screening online, please call Palms Wellington Surgical Center at (561) 792-7333 and ask to speak with the pre-screening nurse.

If you have any questions regarding your health screening or scheduled surgery/procedure please call Palms Wellington Surgical Center at (561) 792-7333, Monday through Friday, between the hours of 8 am to 5 pm.

We look forward to serving you as our patient.