Once you have viewed the educational video, please complete this required brief quiz below. When finished, click "Submit." Your results will be sent directly to the Spine Care Navigator, Shamaila Iqbal. If you have questions, please email either Shamaila Iqbal or Cathleen McCranie.

First Name

Last Name

Phone

Address

Address 2

City

State

Zip Code

Scheduled surgery date (if applicable)

Which Inova hospital?

At which Inova hospital are you having your surgery?

Please complete these questions:

1) I will be expected to get out of bed and walk the day of my surgery, even if I am scheduled to go home the day of surgery.

2) I should take stool softeners and stay hydrated after surgery to prevent constipation.

3) I should shower with chlorhexidine gluconate three times before surgery.

4) After surgery, I will be expected to use a breathing device called an incentive spirometer 10 times every waking hour to prevent pneumonia.

5) My pain will be managed a variety of ways using a pain scale where 0 is no pain and 10 is the worst possible pain. It is best to communicate my pain as soon as possible.

Post-Quiz Attestation

All patients must check the box below to attest that they understand the statement about assistance with everyday tasks following surgery.

I understand that following spine surgery, I will likely need assistance with everyday tasks such as bathing and driving. It is recommended that I have someone at home with me for a period of time based on my recovery needs.

Was our online education helpful?

I felt this education was necessary and helpful to help me prepare for my upcoming surgery.

Additional comments and/or questions:

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Quiz for Spine Patients

Which Inova hospital?

Please complete these questions:

Post-Quiz Attestation

Was our online education helpful?