Patient Health Questionnaire

Your privacy is important to us. The information you provide is stored securely and will only be accessed by authorised Metropolitan Anaesthesia Staff.

The fields indicated with an ‘*’ are required.

Estimates of costing cannot be issued straight away. Once the completed questionnaire is forwarded to the Doctor, they will advise of the Anaesthesia fee and a staff member will be back in contact via phone or email with the Anaesthesia estimate of costing.

***IMPORTANT***

PATIENT PRE-SCREENING

Please contact us as soon as possible and do not attend the rooms if any of the below apply;

• tested positive for coronavirus;
• a fever or a cold or a flu-like illness, including symptoms such as, sore throat, cough, fatigue and difficulty breathing;
• travelled outside Australia and are therefore required to self-isolate for 14 days after date of return to Australia and/or;
• been in contact with a confirmed case of coronavirus and are therefore required to self-isolate for 14 days.