Manhattan Reproductive Surgery Center

65 Broadway, 21st Floor

New York, NY 10006

 

Phone: 212.818.0001  |  Fax: 212.818.0090

MRSC Pre-admission Questionnaire 

 

This questionnaire will help your surgical team at MRSC determine what, if any, preoperative work up will be needed prior to your surgery and help them gather all available medical information about you. 


Step 1: Print the form and fill it out as best as you can.
This information will help to avoid any delay in your surgery. 


Step 2: Please send the completed and signed form to booking@manhattanrsc.com
 

Our Anesthesiology Department will review your answers and determine if further testing or action needs to be taken prior to your scheduled surgery. 


In some cases, we will contact you to schedule an appointment for a preoperative Anesthesia evaluation at our center.
 

If you have any questions, please call Manhattan Reproductive Surgery Center at 212.818.0001.