Anaesthesia: Medical questionnaire

Informed consent and medical questionnaire to be completed before the consultation with your anaesthetist

Information before/during/after the operation (PDF)

Informed consent (PDF)


General Information

This questionnaire will be delivered to the Anaesthetist who will treat it confidentially.
If you are being treated for a heart and/or breathing condition or, if you are insulin dependent diabetic, please make an appointment
with your personal attending doctor for him/her to prepare a detailed medical report for the attention of the Anaesthetist.

If you do please write : name, dosage and schedule.
6. Previous operations and type of anaesthesia: a=general, b=epidural or spinal, c=local
9. Do you suffer from any of the following diseases (check as appropriate)