ANAESDOCTORS

Pre Anaesthetic Questionnaire

pre anaesthetic questionnaire | ANAESDOCTORS

Please fill out the pre anaesthetic questionnaire below and click [submit] to send back to us.
in cm
in kg
DD/MM/YY
1. Have you had general anaesthesia (GA) before?
2. Do you have medical problems in the following areas?
Please specify if you have any other medical problems.
3. Please provide details on any regular medications.
4. Please provide details on any (including medical) allergies.
5. Do you have reflux?
6. Do you have obstructive sleep apnoea?
7. Do you smoke?
8. Do you drink alcohol - more than 2 drinks each day for more than 5 days a week?
Please type the number in the box above
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