Forms

PRE-OPERATIVE INSTRUCTIONS

A Smile MD Anesthesiologist will be administering General Anesthesia while the dentist treats your child’s teeth.
Following the instructions below is critical for the safety of your child. Failure to follow ALL instructions MAY result in cancellation of your surgery. Rest assured, your child will be in great hands with our care team and we look forward to treating them soon!

CRITICAL: No food or drinks, candy, gum, mints or brushing teeth day of
surgery.

NO FOOD OR DRINK AFTER 11PM
*If your child eats OR drinks, the procedure
MAY be cancelled.
*Your child may take routine medications with a SIP of water 2 hours prior to report time.

KEY PARENT INFORMATION:
• Monitor your child to ensure they do not eat or drink anything.
• Do not send them to daycare/school on surgery day.
• Guardian must remain at dentist office until surgery is complete.
• Plan on spending up to 4 hours at the office.
• If your child is of car/booster seat age and weight, you must transport home with a
car/booster seat.
• All jewelry must be removed before case.

WHAT TO WEAR:
• Comfortable clothes and shoes (Please bring a change of clothing in case child soils theirs.)
• NO nail polish.
• NO onesie pajamas!

SICK OR ON MEDICATIONS?
• Call us at (877) 789-8583 if the child has been sick in the past 2 weeks with a cough, cold, fever (or exposure
to COVID in the past 4 weeks).
• Bring inhaler with child if they use one.

POST-SURGERY:
• Child must rest and be monitored for 24 hours after surgery (NO sports, school, or babysitter).

ADDITIONAL INFORMATION:
Please expect a phone call from (877) 789-8583. (CallerID may show SPAM.)
If you do not hear from Smile MD 3 days prior to your child’s appointment, please reach out to us at (877) 789-8583.

* Failure to follow ALL instructions MAY result in cancellation of your surgery.