Cosmetic Surgery Pre-Operative Checklist
Patient Name
Date of Birth
Procedure
Date of Surgery
Medical Evaluation
Medical History Taken
Consent Form Signed
Vital Signs Checked
Allergies Reviewed
Medications Reviewed
Laboratory/Imaging
Blood Tests Completed
Imaging (if required) Completed
Pre-Op Instructions
Fasting Instructions Given
Medication Instructions Given
Smoking Stopped (if applicable)
Notes
Clinician Name
Date