Complete your Online Patient Pre-Admission Questionnaire

Complete your Online Patient Pre-Admission Questionnaire

Glastonbury Surgery Center

195 Eastern Blvd, Glastonbury, CT 06033 (860) 633-0003 ?

Glastonbury Surgery Center offers patients the convenience and Date of Surgery: __________ privacy of a secure, online pre-operative health history intake Procedure: ______________ process. You will be asked about your health history, medications,

and previous surgeries. Login instructions for new and returning Surgeon: ________________ patients can be found below. It is important to complete or

update your questionnaire as soon as possible. Our Pre-Op Nurse will call you prior to your visit to review your information, answer any questions you may have, and provide you your arrival time (if available). We look forward to seeing you soon!

NEW PATIENTS (first-time questionnaire completion)

1. Go online to: 2. Enter password: GSC860SURG 3. IMPORTANT: Save your 32-digit Access Token after submitting your questionnaire. You can

email it to yourself or print a copy. It can be used to revisit/edit your survey at any time.

*You may receive a text message and phone call reminder to complete your questionnaire.

RETURNING PATIENTS (update or edit an existing questionnaire)

Option 1: If you emailed yourself your Access Token: 1. Click the web page link in the email. You will be redirected to a login page. 2. At the login page, your Access Token will be entered automatically. 3. Enter your date of birth using the "MM/DD/YYYY" format. 4. Click "Resume." You can then review and modify your most recent questionnaire.

Option 2: If you printed or saved your Access Token: 1. Go online to: 2. Enter your secure Access Token that you saved or printed. 3. Enter your date of birth using the "MM/DD/YYYY" format. 4. Click "Resume." You can then review and modify your most recent questionnaire.

*If you no longer have your Access Token, please contact the surgery center at (860) 633-0003.

Do I have to complete this? I already gave this information to my surgeon.

What if I don't have a computer?

Do I have to fill out another form if I'm having another procedure? I'm having problems with the website.

Frequently Asked Questions

While we do collect your History & Physical and pre-op workup from your surgeon's office, the surgery center is required to conduct our own interview with you to confirm your complete health history. Our Anesthesia team reviews it and ensures you are qualified for outpatient surgery. Completing this Simple Admit form helps us gather the necessary information we need to ensure we are providing you the best and safest care. Please help us by providing your accurate and detailed information as soon as possible.

You can talk with a friend or family member on the phone who can complete it online for you. You can also complete it on your Smartphone. If you have not completed it before our Pre-Op Nurse calls you, she will complete it with you over the phone.

You can follow the Returning Patient instructions to update your previous questionnaire for your next visit. Our Pre-Op Nurse also calls returning patients and can make any necessary updates with you over the phone too.

Simple Admit offers 24/7 technical support at (877) 848-4726.

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