Mid-America Heart & Lung Surgeons


ESTABLISHED PATIENT POST-OP INFORMATION SHEET

 
Patient Information
Have you received both COVID-19 vaccinations? *

Medications
Are you taking any medications? *
Medication Allergies
Do you have any medication allergies? *
Patient Signature * – Draw your signature below using a tablet, mouse or smartphone. By clicking the Submit button at the end of this form I understand and agree that this is a legal representation of my signature.
 
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