Cuestionario previo al procedimiento

Complete tan pronto como sea posible para que nuestra enfermera de preadmisión pueda revisar su información de salud cuando lo llame 1-2 días antes de la cirugía. Cuando hayas completado el cuestionario, presiona enviar.

  • MM barra DD barra AAAA
  • Cuestionario previo al procedimiento

  • En caso afirmativo, quítese los contactos antes de la llegada y póngase las gafas.
  • En caso afirmativo, le pediremos que retire la ayuda que está en el mismo lado que su cirugía.
  • Utilice sus inhaladores si se usan normalmente por la mañana y lleve su (s) inhalador (es) con usted.
  • Tome medicamentos para el corazón por la mañana, con un sorbo de agua, si normalmente lo hace.
  • Si normalmente toma sus medicamentos para la presión arterial por la mañana, hágalo con un pequeño sorbo de agua. Si toma diuréticos por su presión, no los tome antes de la cirugía.
  • Si toma medicamentos orales o insulina para la diabetes, tome sus medicamentos la mañana de la cirugía y tráigalos.
  • Si es así, traiga una copia.
  • Otras instrucciones previas al procedimiento

  • 1) You will need to be here 1 hour prior to your scheduled surgery. We will call to confirm the time. Please be aware that changes in surgery times do occur. The staff at 4th Street Laser & Surgery Center staff has the final determination. We will notify you of any changes.

    2) You will need someone to drive you home. We ask that they be here when your surgery has ended.

    3) If your surgery is before noon, we ask that you not eat or drink after midnight.

    If your surgery is at 12 noon or later, you may have clear liquids (black coffee, water, or tea without cream or sugar), 4 hours prior to scheduled arrival time, then nothing to eat or drink.

    Any variation of the above instructions may cause a delay or cancellation of your surgery. We will review these instructions with you when we call prior to surgery.

    4)  Please wear a short-sleeve V-neck or button-down blouse/shirt. It is cold in the operating room, so you are welcome to wear warm socks/shoes and/or a vest.

    5)  Bring your insurance card(s) with you. As a courtesy, we will bill your insurance company(s).

    6)  No makeup, hairspray, jewelry/valuables, perfume or cologne (as we are a fragrance-free facility).

    7)  If you are having surgery with Dr. Kersten, do not wear metal, i.e. bra hooks, zipper, snaps etc., as cautery may be used.

    8)  If you are the first patient of the day, the front door will be opened 5 minutes before your scheduled arrival time. There is a doorbell to the left of the main door if there is an emergency.

    9)  If you are a patient of Dr. Kersten’s, we will ask you the name and number of your pharmacy, when we call, should we need to call in a prescription for you to use post-operatively.

    10) If you are having cataract surgery, you will have eye drop(s) ordered that you will need to pick up prior to surgery.


    4th Street Laser & Surgery Center is located at 1720 Fourth Street between Alderbrook and Talbot.

    Eye Care Institute, your surgeon’s office, has two locations in Santa Rosa, one of which is located on Fourth Street as well, (720 Fourth Street - we know, very confusing). If you end up downtown, behind Barnes and Noble, you are in the wrong place.

1720 Fourth Street Santa Rosa, CA 95404 (707) 546-8100