1. Don’t eat breakfast or drink anything, such as milk, coffee, juice etc. on
the morning of the procedure. Take only your blood pressure pills with a
small sip of water.
3. Stop taking Aspirin and Coumadin, at least 4 days before the procedure.
4. You will not be allowed to drive the car after the procedure. Hence,
arrange for someone else to drive your car or take a taxi. Please have
someone accompany you home, after the endoscopy.
5. You cannot go to work or attend your job on the day of the procedure
because of the sedative effect of the drugs used at the time of the endoscopy.
6. Wear loose clothing and don’t put on nail polish an on the day of the
I have received a copy of these instructions.
Date Signature of Patient
Printed Name of