Will I need to arrange for someone to take me home after the test?
What are the risks?
What can the results show?
Will the results change the treatment? Yes
If yes, explain:
No
What can affect the results (for example, food, exercise, medicine, alcohol, or smoking)?
When will the results be available?
Date I will be notified about my test results:
Date for a follow-up appointment:
After the test, what will be the next step?
Will other tests be needed?
Reminders
• Ask about brochures or other information about the test.
• State any concerns you have about the test.
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This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this
information.
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