Orthopaedics

Joint Works Patient Education Class Reservation

Surgical Schedulers please provide patient with FMH Pre-Surgical Education dates / times form for them to PICK their preferred class of attendance during their pre-op visit with their surgeon. Please complete this internet reservation form as their preference form indicates. Once completed, please print and provide the FMH Pre-Surgical Education registration confirmation to the patient with instructions for attendance to the class. This form serves as their registration confirmation for the class. Thank you! Any questions, contact Orthopaedic Program Coordinator 240-566-3785.

Patient Name*
Phone* 
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Email Address
Date of Birth*
Choose Class Date*
Surgeon*
Date of Surgery*
Procedure*
Planned Length of Stay*
Interpreter Desired*
If Yes Please Enter Interpreter Type*
Wheelchair Desired*
1:1 Request*
Additional Requests/Concerns*