Preoperative questionnaire

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.

Download Questionnaire

The questionnaire can be downloaded (save it on your computer) here:

Preoperative Questionnaire (PDF)

After you download and fill out the questionnaire save it and return the completed form to us by our Email:
Of course, you can print out the questionnaire if necessary.