Once you have viewed the educational video, please complete this required brief quiz. Fill in all the fields below and click on the appropriate button (True or False) for each of the statements. When finished, click "Submit." Your results will be sent directly to the Joint Patient Care Navigator at Inova Fair Oaks Hospital. If you have questions, contact us at 703-391-4555. Thank you for completing this quiz. 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 support person or coach I should shower with chlorhexidine gluconate* (CHG) before my surgery. - Select -TrueFalse *The soap can be purchased at most drug stores under the brand name Hibiclens and Exidine. It is okay to continue taking aspirin before my surgery. - Select -TrueFalse I should cough, deep breathe and do frequent ankle pumps after my surgery. - Select -TrueFalse I will be asked to rate my pain using a 1-10 scale. 10 would indicate the highest level of pain. - Select -TrueFalse Please include any additional questions you may have below. Was our online video helpful? Did the video help to adequately prepare you for your procedure? - Select -YesNo Did your support person or coach view this video with you? - Select -YesNo If you feel the video was not helpful, what could we have done better? I understand that completion of this form confirms I would like to receive health and wellness information from Inova. You can unsubscribe if you find it is not meeting your needs.