Anaesthetic Recovery Questionnaire
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When did you have your anaesthesia/operation? *
MM
/
DD
/
YYYY
Time
:
Since your operation/anaesthesia, have you: *
Not at all
Some of the time
Most of the time
Had a feeling of general well-being?
Had support from others, especially doctors and nurses?
Been able to understand instructions/advice (i.e. not confused)?
Been able to look after personal toilet and hygiene unaided?
Been able to pass urine and having no trouble with bowel function?
Been able to breathe easily?
Been free of headache, backache, and muscle pains?
Been free of nausea, vomiting, or dry-retching?
Been free of severe pain, or constant moderate pain?
Please provide any other relevant information or comments.
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