Doctor's Name: Practice Name: Hospital Affiliation: Contact Phone Number: Date of Exam:

1. What type of surgery am I going to require?

2. What exactly happens during this surgery?

3. How large will my incision be and where will it be made?

4. Will I need a bone graft?

5. What type of bone graft options do I have?

6. What are the pros and cons of each?

7. Will there be any implants involved?

8. Who manufactures the implants?

9. What is the success rate with these implants?

10. What kind of post-surgical pain can I expect?

11. How should I qualify or quantify my pain?

12. How long will I be hospitalized after surgery?

13. What kind of post-surgical rehabilitation can I expect?

14. Will I be having physical therapy, if so for how long?

15. When should I evaluate my progress in physical therapy and decide whether or not it is working?

16. Who else will be in the OR during my procedure?

17. Can you refer me to a patient who has had a similar procedure?

18. Who should I call in your office if I have more questions?

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