1. Please do not eat for at least 6 hours before your procedure. 2. Please do not drink any water, tea, coffee, soda, etc. for at least 2 hours before your procedure. Small sips of water to take your usual medications are ok. 3. Please make arrangements to have someone drive you home. If you do not take sedation and do not have a ride home, please plan on staying at the center for at least three (3) hours for monitoring after your procedure. 4. If you take any of the following medications, please contact your primary care physician (PCP) to have the medication stopped prior to your procedure. DO NOT stop these
medications without first talking to your PCP:
a. Coumadin (warfarin) b. Plavix (Clopidogrel) c. Pradaxa (Dabigatran) d. Aggrenox (Diprymidamole/aspirin) e. Persantine (Dipryidamole) f. Lovenox (Enoxaparin) g. Ticlid (Ticlopidine) h. Heparin i. Any other “blood thinner”not listed above 5. If you are diabetic or hypoglycemic you should have your appointment scheduled before 10:00 A.M. and test your blood sugar at home prior to your procedure to report the results to the staff. 6. If you are pregnant, you cannot have an injection as X-rays are used for the procedure. If there is any chance that you may be pregnant, contact us. You may be required to take a pregnancy test at home and report the results to the staff. 7. If you are currently taking (or have taken in the last 10 days) any antibiotics, please inform the physician’s office prior to arriving at the center for your procedure as you may need to be rescheduled. 8. If you have a fever greater than 100° F, cold, flu or any other sign of infection, please contact the physician’s office prior to arriving at the center for your procedure as you may need to reschedule. 9. If you are not able to make your appointment, please contact the physician’s office (303- 355-3700) to reschedule 24 hours in advance. 1. Avoid strenuous activity and lifting for 24 hours unless told otherwise by the doctor. Consult with your physician for any further instructions. 2. If you have received sedation or pain medication do not drive, drink alcohol, operate machinery, sign legal documents, or make any legal decisions for 24 hours. 3. You may resume your normal diet and take your regular medications unless directed 4. If you are tender over the site of the injection you may use an ice pack wrapped in a towel for 20 minutes 3-4 times per day. 5. Do not apply heat to the area. 6. Your usual pain may get worse over the next 24-48 hours. 7. You may experience prolonged drowsiness or confusion if you received sedation. 8. There may be swelling, redness, drainage, or pain at the injection site or IV site. 1. If you experience new severe back or neck pain, new significant numbness or weakness of your arms or legs, loss of control of your bladder or bowels, or signs of infection (fever, drainage, swelling, significant redness) in the area of the injection or IV site. Call the center at (303) 355-3700. If no one is available or other than our usual business hours immediately call 911. 2. NO MEDICATIONS will be prescribed over the phone. I have read and understand the above instructions. Printed Name



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