Surgery at White Plains Hospital Pre-Op Forms

You may download the following pre-op forms and bring them to your appointment.

• Pre-Operative Testing Orders
• Pre-Operative History and Physical
• Admissions Health History
• Medication List Worksheet
• Doctor's Order Sheet
• Blood Transfusion Consent
• Surgical Consent
• Day of Surgery Admission Orders
• Consentimiento Para Cirugía (Surgical Consent in Spanish)
• Refusal to Permit Blood Transfusion
• Pediatric Pre-Procedure History and Physical