Welcome to Hunter Specialty Anaesthesia

Book a Consult with Dr Rothwell

Welcome to Hunter Specialty Anaesthesia

Book a Consult with Dr Rothwell

Welcome to Hunter Specialty Anaesthesia

Book a Consult with Dr Rothwell

appointment

On April 22nd 2017 by admin

Book a Consultation

YOUR DETAILS:

Surname

First Name

DOB

Gender

MaleFemale

Address

Your Email

Your Phone Number

Health Fund

Fund Number

Medicare number

Position you appear on card

Surgeon

If ‘other’ please specify

Hospital

If ‘other’ please specify

Name of Operation/Procedure

Have you been given a date for your Operation/Procedure?

YesNo

If ‘yes’ please enter the date below

Name and telephone numbers of your doctors (GPs and Specialists)

Do you give your consent for me to contact your other doctors if required?
(to provide you with the safest anaesthetic your anaesthetist may need to contact your other doctors to obtain test results, specialist letters, or other information. This allows better understanding of your health, meaning your anaesthetic can be individualised appropriately)

YesNo

Your anaesthetist will receive all the information submitted via this questionnaire. Depending upon your answers, your anaesthetist may decide to contact you to obtain more information, or simply to discuss particular aspects of the anaesthetic. Alternatively, your anaesthetist may be satisfied with the information submitted and be ready to proceed with your anaesthetic as is.

By submitting this form you confirm the information provided is true and correct to the best of your knowledge and can be relied upon by your anaesthetist in making clinical decisions.

Send me a copy of this message (email only)

Please enter the email address to send this to

If the confirmation email does not appear in your Inbox please check your Junk/Spam folder

Now please take the time to complete the Patient Questionnaire to provide Dr Rothwell with important information he requires to provide you with the best care.

Pre-op Questionnaire