1.  If you have been told by a doctor that you have an abnormal pap smear / or have been suffering from chronic pelvic pain for more than six months, then you may qualify for our same day treatment option.
2. Obtain a copy of abnormal pap smear if possible
3. Review instructions and fill out information form before calling our office.
4. Call office with information ready to make an appointment.
5. Once travel arrangements have been made, call for airport pick-up and accommodation information.
6. Arrive at our office at least 15" before scheduled time in morning (local hotel pick-up available)
7. NOTHING to eat or drink after midnight the night before appointment.

Information Form: Information you will need when you call our office. (or e-mail this form or print out this form and fax it to 912-871-2510 and we will call you):

	Name
	Date of Birth
	Address
	Daytime Telephone Number
	EMail Address
	Problem		Abnormal Pap Smear Chronic Pelvic Pain Pain With Sex Painful Periods
	Insurance Company
	Insurance Policy Number
	Effective Date
	Abnormal Pap Smear Results: Patients must bring a copy of results
	Past Medical History: Please list problems with the heart, lungs, blood, stomach, kidneys, bladder, bones and joints, or nervous system.
	Any Previous Treatment for Abnormal Pap: colposcopy with biopsy, endocervical curretage (ECC), cone biopsy, or LEEP
	Any Chronic Medical Disease?		None Heart Disease Lung Disease Kidney Disease Problems with Anesthesia Diabetes Bleeding Problems
	Medications: Please list all medications you are taking and current doses. Also list any over the counter medicines and herbals or supplements.
	Allergies: Please list allergies to antibiotics, medications, latex
	Any Previous Surgery
	Any Previous Anesthesia Complications?