Introducing:

Comments:

1. Nothing to eat or drink for at least 8 hours before appointment (including water)2. Required oral medications may be taken with a SIP of water at least 2 hours before

surgery.3. A parent or legal guardian must accompany minors.4. A adult driver must accompany patient.5. Please wear comfortable, loose fitting clothing and remove contacts and jewelry.6. Any questions? Please call our office.

Referred By:

Referral For:

� Extraction � Implant/Bonegraft � Pathology � TMJ � Exposure

X-RAY(s): � Given to Patient � Mailed � E-Mailed � Please Take

10 South Street, Ridgefield, CT 06877203-403-3686 � www.ridgefieldoralsurgery.com

Instructions for Patients Receiving General Anesthesia

Date:

For APPLE Phones (Use Apple’s Safari Browser)Click the “Up Arrow” at the bottom center of the app and then select “Add to Home Screen”

For ANDROID Phones (Use Google Chrome Browser) Click the on the “3 vertical dots” on the top right MENU and select “Add Shortcut to Home”

1. SCAN QR Code

2. Or TYPE the URL on bottom of form

www.ridgefieldoralsurgery.com

New Patient Smartphone APP

Takes NO Space on Your Phone!EASY TO LOAD!