The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit North American phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

duLF63ZZ7x6pvUpmKTmj8Jyoxkh2Bnvosjy2TBQ7ouu

Pre Operative Health History

Returning?

A A A

Thank you for choosing Seton Healthcare Family for your surgery. In order to provide the very best care for you during your sugical experience at Seton, we ask that you answer the following questions about your medical conditions. Certain conditions may need special care for you, or change the timing of your surgery. It is very important to your care that you please answer these questions carefully and as accurately as possible. There is no right or wrong answer. Your answers are confidential (private).

Please complete the health questionaire below.

Thank you!

Enter your first name :

* must provide value

Enter your last name :

* must provide value

Enter you date of birth:

* must provide value

What location are you having your surgery?

Seton Medical Center Hays

Seton Medical Center Williamson

Dell Seton Medical Center at The University of Texas Austin

Seton Medical Center Austin

Seton Highland Lakes Hospital

Seton Northwest Hospital

Seton Southwest Hospital

reset

What is the best number to reach you at ? List the best time to contact you .

* must provide value

Enter your email address :

Please list the name of your primary care doctor. Please include address and phone number if available. List any upcoming appointments.

Please list any other specialist that you see. For example: cardiologist, neurologist, oncologist ect. If you have any upcoming appointments please specify when.

What is the name and phone number of your emergency contact?

What is your pharmacy of choice?

What is your height:

What is your weight lb/kg:

What is your goal for this surgery? What are you looking forward to the most after your recovery?

* must provide value

Who will be your "support person" through your surgical process? ( The person who will assist you before and after surgery)

Will this person be the one caring for you at home if no, list name and phone number of who will help care for you.

Will you live with someone who can care for you after your operation?

* must provide value

Yes

Unknown

reset

Do you have transportation to the hospital, and someone that will drive you home from the hospital?

Yes

reset

Have you traveled outside country in the last 28 days?

* must provide value

Yes

reset

If so where?

Please add additional comments here:

Expand

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.