ANAESTHETIC PREASSESSMENT
You have been referred to me for a future procedure. Would you please complete this questionnaire as soon as possible and return it to me? This will allow me to check if any tests or special preparations are required and avoid the risk of delay or cancellation.

Further information is available at 


and you are welcome to email me with any questions at anaesthesia@unconsciousness.net

Dr Aubrey Bristow, Consultant Anaesthetist
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Your name
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Your email please
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and your telephone number
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Your date of birth
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MM
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DD
/
YYYY
Your weight including units (Kg or stones or pounds):
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Have you ever been under my care before?
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The planned operation
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The date of the operation
*
MM
/
DD
/
YYYY
Your insurance company if relevant
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Have you had a general anaesthetic before?
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