Initial Patient Screening

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Dedicated to providing high-quality anaesthetic and perioperative care for patients and surgeons of Central Highlands and surrounding communities.

Initial Patient Screening

Height (metres)

Have your ever seen a cardiologist? *

Yes

No

Have you ever had a heart attack? *

Yes

No

Do you have a pacemaker? *

Yes

No

Do you have any stimulator devices (Brain/Spinal?) *

Yes

No

Weight

Do you take blood thinners? *

Yes

No

Do you have any issues with bleeding? *

Yes

No

Do you have any kidney issues? *

Yes

No

Do you have diabetes? *

Yes

No

Have you or a relative had a significant reaction to anaesthetics *

Yes

No

Screening Assessment Result

Dr Michael Bassett copy: Testimonials

Contact

101 Drummond St North

Ballarat, Victoria 3350

03 43134404

info@chaa.net.au

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Dedicated to providing high-quality anaesthetic and perioperative care for patients and surgeons of Central Highlands and surrounding communities.

Initial Patient Screening

Screening Assessment Result

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Contact