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BEFORE SURGERY

Pre-operative questionnaire

Please complete this questionnaire before your procedure. The information you provide will help me review your medical history, medications and other factors relevant to your anaesthetic.

Before you begin

Please have details of your medications and medical history available.

Your personal and health information will be handled in accordance with our Privacy Policy

Prefer to complete a paper form?

Download and complete a paper copy.

Pre-operative questionnaire (PDF) →

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Patient Details
Title
Sex

If you are completing this form on behalf of someone else.

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