Please print and fill out this form prior to your scheduled appointment.

• Patient Registration Form
• Health History Form

Avoid the following for 48 hours before your procedure: ALL nuts, seeds, popcorn, skins of raw fruits and vegetables.

Do not drink or eat any food colored red or purple.

You are not permitted any alcoholic beverages 24 hours before or after the procedure.

Clear liquid is any beverage you can see through. Honey, sugar, sweetner, and lemon are permitted.

Beverages:

• Soft drinks (orange, ginger ale, cola, Sprite, 7-Up, etc.), Gatorde, Kool-Aid
• Clear fruit juices without pulp (apple, white grape, lemonade, etc.)
• Water, tea or coffee (no milk or non-dairy creamer)

Soups:

• Clear bouillon/broth (any flavor)

Desserts:

• Hard candies (Jolly Ranchers)
• Jello (lemon, lime or orange; no fruit toppings)
• Popsicles, Italian Ice (no sherbets or fruit bars)