Patient Ready

Welcome! We Start With You

For us to deliver the highest quality and most comprehensive care possible, we need to know a bit about you. Sharing your health history information will allow us to assess your well-being, optimize you for surgery, and help you maximize your recovery.

All health information you share with us is completely confidential and secure.

Returning Patient?

Legal First Name

Legal Last Name

Gender

Date of Birth

Last 4 of SSN

Height (in)

Weight (lbs)

Mobile

Messaging Preference

I consent to the use of email and/or text message (SMS) for communication. I understand that email and SMS messaging are not encrypted, and my personal health information could be viewed by a third party.^*

Surgery Details

Your Surgeon

Other Contact Information (Optional)

Caretaker Name

Caretaker Phone

I am physically dependent upon a caregiver for daily activities and self-care

My caregiver listed above is also my transportation

Driver Name

Driver Phone

Sign me in (only recommended if this is a trusted device)

* Note: Without consent, PatientReady will not be able to share the results of your personalized risk-strafication or pre-procedural recommendations with you. All Personal Health Information (PHI) stored within PatientReady is encrypted. Message frequency varies. Message and data rates may apply. By continuing, you agree to our Privacy Policy or SMS Terms

By continuing, I acknowledge that PatientReady will share my health information with clinical and healthcare operations staff at any/all facilities at which I enroll, and that in the future, PatientReady may share that information with other facilities of my choosing.