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Pre-Anaesthetic Questionnaire

Your Consent
Why do I need to complete this questionnaire?
By providing some details about your general health, we can decide upon the safest way for you to proceed with your planned surgery.  Some patients may require additional tests before surgery can go ahead and a small number may need to see one of our Consultants in a clinic.  If we do not have all your health information ahead of your operation date, there is a risk that your surgery may not be able to go ahead as planned on that day.

What do I have to do?
We will ask you for some basic health details including any illnesses that you have, any medicines that you take and any previous operations that you have had.  Most of the questions are simple tick-boxes but there is plenty of space to leave as much information as you need.  The questionnaire is optimised for use on mobiles phones and tablets as well as PCs or Mac computers.  

How long will it take me?
For most people, the questionnaire should only take around 10-15 minutes to complete.  There is a progress bar at the bottom of each page to show you how far through the questionnaire you are.  The 'next' button will take you to the next page of the questionnaire.  You can review and change any of your answers by using the 'back' button located on every page, before finally clicking 'Submit' on the last page.  You can also save your progress and return to complete the questionnaire another time, by clicking on the 'Save and continue later' option at the top of each page.

Is the information I enter into the questionnaire secure and confidential?
Absolutely!  This online questionnaire is written by and maintained by STAAG Consultants only.  No one outside of our group is involved in collecting or reviewing your data.  The website we use (SurveyGIzmo) is compliant with HIPAA (the Healthcare Insurance Portability and Accountability Act) which is the American national standard required to collect healthcare information - there is no current UK equivalent.  The links to this questionnaire are all secure, the data you enter is encrypted and it is only accessible only by us, via our Professional business account with SurveyGizmo. Finally, your data is entered onto servers located in Europe, not the USA, as per NHS data management guidelines.

I have a question I'd like to ask about this questionnaire before I complete it?
Please contact our Practice Manager who will redirect your query to one of our Consultants if needed.  The contact details can be found on our website -  Contact STAAG
 
How will my data be used?
Once you finish completing the questionnaire, a copy of it will be emailed to one of our Consultants.  You will have the opportunity to enter your email address to receive a copy too.  Your information will be reviewed and forwarded to the hospital where you will be receiving your treatment, along with any recommendations that we make regarding further testing or consultation.
 
1. Please confirm your consent to completing this Pre-Anaesthetic Questionnaire. *This question is required.
As you do not feel able to complete our online Pre-Anaesthetic Questionnaire, please visit our website, where you can download a paper questionnaire to print and return to us by post.

Paper Pre-Anaesthetic Questionnaire