For ensuring the safest and most agreeable possible course of your forthcoming surgery requiring anaesthesia, information on your state of health is of the greatest importance to us. Therefore, we ask you to please thoroughly and completely fill in the questionnaire you will find below as PDF file. You can download, print and complete it by hand. Then hand it over to your general practitioner or send it to us directly by mail.

If your surgery already will already take place in 2–3 days, you can give the completed questionnaire directly to the anaesthetist when you enter the hospital. Do not hesitate to make use of our consultation if you have any questions