Preoperative questionnaire contains the following:
- The basic demographic data
- Basic medical data
- A questionnaire on health status that is filled by the patient or legal guardian.
Instructions for patients
This questionnaire helps in providing the best possible care before, during and after treatment.
- It is important that you accurately complete all portions of the questionnaire. All data collected by the questionnaire are for your safety and will be considered confidential.
- Please as soon as possible return the completed questionnaire via email, the administrator / nurse at the institution where you got it, or possibly send the fax.
- When you return the questionnaire by email or submitted to the administrator / nurse, you will be contacted by phone or e-mail and will arrange the details about your reception. In the event of any change in your contact information (phone, address, e-mail), please let us know as soon as possible so that we could at any time be able to reach you.
- Do not forget to bring a list of medications you are taking, dismissal letters and important X-ray / CT / MR images that are related to your current situation.
The questionnaire can be downloaded (save it on your computer) here:
After you download and fill out the questionnaire save it and return the completed form to us by our Email: firstname.lastname@example.org
Of course, you can print out the questionnaire if necessary.