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Home
Make an appointment
our team
Consultants
Audiologist
Administrative Team
What we offer
Paediatric ENT
Adult ENT
Audiology Services
Childrens allergy
Clinic diagnostics and procedures
Urgent appointments
Balance/Vestibular
For Patients
Patient forms
administration information
medical information
what our patients think of us
fees
Contact
Contact
How to find us
Search
Name
*
First Name
Last Name
Have you had a previous general anaesthetic?
Yes
No
If yes, were there any problems?
Is there a family history of problems with general anaesthetics?
Yes
No
If yes, please list
Do you have any allergies to any medications?
If yes, please list
Are there any bleeding disorders in the family?
If yes, please explain
Are you on any medications including herbal supplements?
Yes
No
If yes, please list
Do you have any loose teeth - if so which?
Please let us know if there is anything you would like the anaesthetist and surgeon know before the surgery?
Do you have any other medical problems such as:
Asthma
Heart Disease
Diabetes
Thank you!
