First Name Last Name Email Phone Address Address Address 2 City State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Date of surgery if known Name of coach or support person Quiz questions Your coach, who is a family member or friend, should accompany you on your pre-op day at the hospital. - None -TrueFalse During your pre-op visit, the nurse will tell you what time you should stop eating and drinking prior to your surgery. - None -TrueFalse You should continue taking your required medications with a sip of water. - None -TrueFalse You will be asked to mark the leg you are to be operated on with a "Yes." - None -TrueFalse After your surgery you should always call a nurse before you try to get up. - None -TrueFalse Please indicate below any questions you may have. Was this online video helpful? Do you prefer to take this orientation online (like this), or would you rather go to the hospital and hear the information provided by one of our staff in a class? - None -OnlineHospital orientation class Did your coach or support person view this video with you? - None -YesNo If you feel this video was not helpful, what could we have done better? By submitting this form, you are confirming that you would like to receive health and wellness information from Inova. You can unsubscribe if you find it is not meeting your needs.