Page 1 - Total Hip Packet

Dr. Christian Eccles
Hip and Knee Replacement Surgery
2940 E. Banner Gateway Dr. #200, Gilbert, AZ 85234
1675 E Melrose St, #101, Gilbert, AZ 85297
Phone: 480.964.2908 | Fax: 480.388.3519
Medical Assistant (Reese) extension: 3186
Surgery Scheduler (Debbie) extension: 4141

IMPORTANT DATES
Use this form to keep track of your appointments

Schedule a medical clearance appointment with your Primary Care Physician

Date: ____________________ Time: _____________

If needed schedule a medical clearance appointment with your Specialty Physician(s)

Specialty: ____________________ Date: ____________________ Time: _____________

Specialty: ____________________ Date: ____________________ Time: _____________

PRE-OPERATIVE APPOINTMENT WITH DR. ECCLES

 2940 E. Banner Gateway Dr, #200, Gilbert, AZ 85234

 1675 E Melrose St, #101, Gilbert AZ 85297

Date: _________________ Time:_________________________

You need to have all pre-operative testing/clearances done before your appointment.

SURGERY DATE AND TIME

Location: Arizona Spine & Joint 4620 E Baseline Rd, Mesa, AZ 85206

Date: _____________________ Time: Debbie (Surgery Scheduler) will call you the afternoon

before with your check in time.