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1. Please make appointment for :

Office C10  _______  Month  ____ Day  □ A.M.    □ P.M.    

2. Water and food fasting in 8 hours before the therapy.

Signature : _______________

3. Do not drive or ride scooter on the day of surgery.
4. Please bring you National Health Insurance Card.
5. On the day of surgery, family ( aged 20 years or old ) should company the patient and fill out the “ Agreement of Surgery ” and “ Agreement of Anesthesia ” together.
6. Please report to the Shock Wave Lithotripsy on the 3^rd floor in Li-Fu Medical Building by the appointed time.

Please arrive on time to avoid delay.