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Common Questions
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Inova Neurosciences
Quiz for Spine Patients
Inova Spine Program
A
A
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You must have JavaScript enabled to use this form.
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
Email
Phone
Address
Address
Address 2
City
State
- Select -
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces (Canada, Europe, Africa, or Middle East)
Armed Forces Americas
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Scheduled surgery date (if applicable)
Which Inova hospital?
At which Inova hospital are you having your surgery?
- Select -
Don't know yet
Inova Alexandria Hospital
Inova Fairfax Hospital
Inova Fair Oaks Hospital
Inova Loudoun Hospital
Inova Mount Vernon Hospital
Please complete these questions:
1. I should shower with chlorhexidine gluconate* (CHG) before my surgery.
?
- Select -
True
False
2. It is okay to continue taking aspirin before my surgery.
- Select -
True
False
3. I should cough, deep breathe and do frequent ankle pumps after my surgery. I will be asked to get out of bed the day of my surgery. Even if I go home the day of surgery, walking and expanding my lungs (occasional deep breathe and cough) will prevent complications.
- Select -
True
False
4. I will be asked to rate my pain using a 0-10 scale. 10 would indicate the highest level of pain.
- Select -
True
False
5. Please include any additional questions you may have below.
Was our online education helpful?
Do you feel that this online education gave you the necessary information to prepare you for your upcoming spine surgery?
- None -
Yes
No
If no, what do you feel we could have done better?
Any additional comments?
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