Sievering Clinic

Competence Centre for Minimally Invasive Medical Services

Patient Care

Prepare your visit

First Time Visit (and each visit)

Medical History Form:

As a new patient, you have a lot of background to share with a new physician. In order to make sure you understand your condition and treatment, ask your doctor these questions and write down the answers to review when you are home. Print this form to take with you on your first (next) appointment.

Click here to fill out the medical history form

General information

Show your doctor that you’re all business by arriving on time for your appointment. This shows that you respect his time and that he should also value yours. Also, be kind to the good doc and follow mom’s advice by showering and putting on clean underwear beforehand.


In the case you should need anesthesia it is forbidden to drive or manually operate machines for 24h.

Bring to the Appointment:
  • Insurance Card
  • Referral Forms (if applicable): You are responsible for obtaining your referral.
    Do not rely on your general practitioner’s office to fax or mail us the information.
    These are crucial pieces of data needed for the first visit.
  • Previous Health Records
    • Pertinent medical records (x-rays, blood work, growth curves, etc.)
    • Medical history form
    • Information about premedication
  • Awareness of coagulation-active substances (Marcoumar, Sintrom, Thrombo ASS, Aspirin)
Prior exam results
You must bring to the clinic all test results in your possession, including:

  • your blood type
  • HIV
  • Hepatitis
  • If you are to undergo a polypectomy, you must bring your test results on lower limit of platelet count.
Preparation for different tests:
Vein Care Centre

Varicose vein surgery

Since surgery for your varicose veins as been arranged please read the following carefully:
Your surgeon may suggest that if you are taking the oral contraceptive pill, it should be stopped one month before the operation. This is to reduce the risk of thrombosis. However, it is very important that you think about other contraceptive methods. Alternatively, he may give you an injection to thin the blood before the operation. You may be called for a pre-admission visit about one week before your actual date to make sure you are fit for the operation. The operation is usually performed as a day-case. However, if you are having both legs operated upon, or if you have any medical problems, it is usual to remain in hospital overnight.
Gastrointestinal Centre
The range of tests includes all outpatient endoscopy, and invasive procedures such as endoscopic polypectomy and mucosectomy, endoscopic insertion of esophageal stent and percutaneous gastrostomy (PEG).

You should obtain a written consent prior to each endoscopic evaluation.
An information discussion should take place in the clinic at least 24 hours prior to the test.

Duodenoscopy (Oesophagus)
Fasting for 8 hours or on the eve (approximately 20:00 clock)
Manometry (Oesophagus)
Fasting on the eve (approximately 20:00 clock)
Examination day: Clysmol in the morning. Breakfast is allowed.
Colorectal Centre
Day before: only liquid foods (tea, soup), take X-Prep by 16 clock.é Drink at least 3l.
Examination day: Clysmol in the morning. Breakfast is allowed. Drink lots of fluids.
Preparation for colonoscopy
Fasting on the eve (approximately 20:00 clock)
Rectal endosonography
Examination day: Clysmol in the morning. Breakfast is allowed.