top of page

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.

​

Please have details of your medications and medical history available before you begin.

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

Prefer to complete a paper form?

If you are unable to complete the questionnaire online, you can download and complete a paper copy.

Download pre-operative questionnaire (PDF) →

Patient Details
Title
Sex

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

bottom of page