Please call 573-651-5830 for questions regarding this form.
This information will be reviewed by your Anesthesiologist prior to surgery and will help to prepare and provide safe anesthesia and nursing care for you.
If you would like us to maintain a copy of your Advance Directives on your medical record, please bring it with you.
If you would like us to create an Advance Directive, please print and complete the form and bring it with you. If you have any questions, do not hesitate to discuss them with us.