To be able to provide the best anaesthetic care for your upcoming procedure, your anaesthetist has requested that you complete the following questionnaire.

The questionnaire will take approximately 10 minutes to complete and requests information including any current medical conditions and medications.

Your completed questionnaire will be forwarded to your anaesthetist, who will contact you directly if further information or clarification is required or if you have noted a particular concern and requested that they contact you.

Contact Details

Pre-Anaesthesia Questionnaire

Question
Details
Medical History
Yes (tick)
No (tick)
Details (Please provide a detailed description for any questions you have answered Yes)
Probills client workflow

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