LACTOSE / LACTULOSE TOLERANCE TESTING

You are scheduled for a Lactose Tolerance Test on _______________________________________

Before your procedure:

• No Enema or Barium Studies for two (2) weeks prior to your procedure. If you are experiencing severe diarrhea, it will be necessary to reschedule your procedure.

• No antibiotics for two (2) weeks prior to your procedure.

• No smoking for a least one (1) day prior to your procedure.

• Limit all starches and sugars (such as those found in processed and/or pre-packaged foods) for a minimum of one (1) day prior to your procedure.

• Nothing to eat or drink for least twelve (12) hours prior to your procedure. (This includes gum, mints, candy, water, etc. When brushing your teeth, do not swallow the water or toothpaste).

Fasting begins at 9:00 PM the night before your procedure.

• No physical exertion, sleeping or eating during the exam.

• Your procedure lasts approximately three (3) hours, beginning at 8:30 am to approximately 12:00 pm (noon). Please arrive promptly at our office for your procedure at 8:30 AM.

If you are 18 years old and younger, you must be accompanied by a parent/legal guardian for your procedure

rev 04/06 Form114/214