Premium Plan members can change their pre-op health questionnaire as often as they like. We offer unlimited levels of depth to questions (responsive based on previous answers). We also allow complex questions, triggers, confirmations and notifications. That’s right – Premium Plan members receive unlimited changes, all included in their flat monthly subscription.
Examples of Premium members Pre-Op Questionnaire changes
Premium Plan members can tailor the questionnaire to their exact requirements. There’s very little we can’t update for you – we want to make sure you are really getting the most out of this plan and completely happy with every question, improving your efficiency. Here are some of the excellent changes our amazing members have come up with:
Click on the ‘…‘ link to see more details and use the form at the bottom for changes
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- Add – Email invoice checkbox …
- Add – Notification to billing secretary …
- Remove Age – Calculate from date of birth …
- Add – Repeat procedure question …
- Amend – Are you well question …
- Add – If Child – Significant medical issues in first 12 months …
- Amend – If Child – Heart question …
- Add – If Child – Brain etc problems …
- Add – If Child – Syndrome question …
- Add – If Child – Immunisation record …
- Amend – Stroke question …
- Add – Exercise question …
- Add – Cancer question …
- Amend – Split smoking / drinking question …
- Add – Extra smoking questions (e.g child environment) …
- Add – Smoking warning …
- Add – Recreational substances question …
- Amend – Medications list (and upload) option …
- Add – Medications warning box …
- Add – Medications surgeon question …
- Add – Non-Prescription medications …
- Add – Recent blood test question …
- Add – Liver condition question …
- Amend – GORD question to include gastric band surgery …
- Amend – Shortness of breath options …
- Amend – OSA questions …
- Add – Extra Asthma questions …
- Amend – Pregnancy (original questionnaire) …
- Amend – Extra page uploads (original questionnaire) …
- Add – Risk question …
- Amend – IFC / fee basic options …
- Amend – IFC / fee advanced options …
- Amend – IFC / fee automated request …
- Add – Medicare and My Health Record …
- Add – Direct Deposit / EFT details …
- Amend – Someone to collect …
- Add – Other alerts / messages …
- Amend – Confirmation message …
- Add – Extra pages (ANZCA docs) …
- Amend – Profile picture as hospitals list …
- Add – Patient review form before submit …
- Add – Do you snore …
- Amend – Excessive Bleeding …
- Amend – Gender Non-Binary option …
- Change – Notification message …
- Amend – Anaesthetic problems warning & examples …
Premium possibilities
- You can add or remove questions, according to their relevance
- You can also create conditional questions, based on the details input by your patient (with an unlimited depth)
- In addition, you can customise confirmation messages sent to your patients, yourself, and your office (For example: If the patient requests a quote, we can show them a quote based on the procedure / surgeon entered or even simply email their basic (non-medical) details to your billing secretary to reply)
- You can opt to update the form or questionnaire styling. This could be the inclusion or removal of page breaks, or specific text, buttons, and displayed messages
- You can create special conditional logic triggers (For example: If your patient is over 60 and male, we can ask them different questions than we would ask a younger male or even a female the same age)
There are endless options for your customisations and so, all changes to your forms and questionnaire will be free for the lifetime of your Premium Plan. Because we manually change the form for you, you can continually tweak it until it’s just right.
How to make a change
If you’d like to make a change or for more information – reply to one of our emails, call us or fill in the form at the bottom of this article. Or for more information on what’s included in the Premium Plan please click here.
Extra Details of the changes
1. Email Invoice Checkbox
If the patient enters an email address into the form, we can show a checkbox asking if they give authority for their invoice to be sent via email
Example: I give authority for my invoice (if applicable) to be sent via email
CREDIT – Dr Anna Pedersen
Request
2. Notification message to others (e.g billing secretary)
Create an extra notification go to others (with no medical data) like your billing secretary
Example: If the patient selects Yes to a request for a quote, we can email your billing secretary their basic contact details (no clinical data)
CREDIT – Dr Brenton Coats
Request
3. Calculate Age from Date of Birth
Currently most forms ask the Age and also the Date of Birth of a patient. We have the ability to only ask the Date of Birth and then in the questionnaire sent to you we can automatically calculate the age. This would make it easier for the patient as they wouldn’t have a double up of the question.
However, a problem with this is the calculation is to the nearest whole number so this may not suit paediatric anaesthetists (patients can enter 1.8 to signify the patient is 1 year and 8 months old, or however you word the age decimal on your form).
Following questions can still be dependant on age (e.g if the calculated age is <18, child questions can still be asked).
CREDIT – Dr Steve Clulow
Request
4. Repeat Procedure Question
Ask the patient if the operation is a repeat procedure.
If Yes is selected, a detail / paragraph box can appear where the patient can provide more information
Example: Is this operation a repeat procedure for an existing condition (eg. second set of grommets)?
CREDIT – Dr Steve Clulow
Request
5. Amend the Are You Well Question – multiple change examples
Some members change the period in question (currently the default is 2 weeks)
Example: If your surgery is within the next three weeks../ Have you been sick in the last three weeks..Some members have a different question for children. Ask if they’ve had a cough, runny nose, cold or fever and if yes then a different box pops up
Example: Are you well now? Eating normally? Playing normally?Another option is to ask about respiratory tract infections within the last two weeks and then also ask about a cold or flu in the last six weeks.
If Yes is selected for either, a detail / paragraph box can appear where the patient can provide more information
Example: Any significant respiratory tract infections within the last two weeks? (significant symptoms which could impact on the safety of an anaesthetic include fevers, rigors (shivering sweats at night), chesty moist productive coughs, shortness of breath, or being obviously unwell. Note – do not select ‘Yes’ for a simple cold or runny nose)
Also:
Example: Any cold or flu symptoms in the last six weeks? (including a simple cold, runny nose, wet or dry cough, fever or just feeling generally unwell)
Then small boxes can pop up asking for more details:
What were your symptoms? (e.g headache, congested, sputum production, cough etc)
How do you feel now? Do you still have a cold or flu?
How long since your cold or flu finished?
And a paragraph box:
Please provide any other details
CREDIT – Dr Anna Pedersen & other members
Request
6. Child – ask if significant medical issues in first 12 months
Only show this question if the age is less than 16.
If Yes is selected, a detail / paragraph box can appear where the patient can provide more information
Example: Any significant medical issues in the first twelve months of life? (this can include prematurity, time in the Special Care Nursery (SCN) or Neonatal Intensive Care Unit (NICU), or admissions to hospital for any reason)
Request
7. Child – change the heart question
Only show this question if the age is less than 16 and also the other heart question (asking about heart attacks, pacemakers etc) can be removed
If Yes is selected, a detail / paragraph box can appear where the patient can provide more information
Example: Any trouble with your heart or cardiovascular system? (this could include murmurs, holes in the heart, past visits to a cardiologist, past heart surgery)
Request
8. Child – other problems question
Only show this question if the age is less than 16.
If Yes is selected, a detail / paragraph box can appear where the patient can provide more information
Example: Any brain, nerve or muscle problems? (this could include cerebral palsy, epilepsy, developmental delay, autism, behavioural problems)
Request
9. Child – syndrome question
Only show this question if the age is less than 16.
If Yes is selected, a detail / paragraph box can appear where the patient can provide more information
Example: Do you have a syndrome?
Request
10. Child – immunisation history
Only show this question if the age is less than 16. An upload box can also appear
Example: Please upload a copy of the child’s immunisation record. Alternatively you can note the last immunisation below or securely send the record to Dr xx later via the contact form on his profile page
CREDIT – Dr Chris McMahon
Request
11. Heart question to also ask about strokes
The Standard questionnaire asks about strokes in the question regarding “Neurological Condition? (this could include a stroke, mini-stroke, TIA, multiple sclerosis, Parkinson’s disease or epilepsy)”
Some members also ask in the heart question if the patient has had a stroke
Example: Any trouble with your heart or cardiovascular system? (this could include high blood pressure, chest pains, angina, heart attacks, coronary artery stents, coronary artery bypass surgery, heart rhythm problems, having a pacemaker or defibrillator, strokes or mini strokes)
Request12. Exercise ability question
Ask the physical activity level of patient and if an activity is selected a box can also appear advising them not to exercise the morning of the procedure
Example: What type of physical activity are you able to do?
Options:
Light intensity – eg. walking
Moderate intensity – eg. swimming, tennis
Vigorous intensity – eg. jogging, aerobics
None – I am not able to do any exercise
If any intensity is selected, a note can pop up:
Please do not exercise the morning of your operation as you are likely to be fasting and will subsequently be dehydrated
CREDIT – Dr Chris McMahon
Request
13. Cancer history question
Ask if the patient has had cancer treatment.
If Yes is selected, extra questions can appear so the patient can provide more information
Example: Have you had cancer treatment?
Then if yes a new page can show with more questions
– In which part of your body was cancer identified?
– Did you have Chemotherapy?
– What was the type of Chemotherapy?
– Did you have Radiation Therapy?
– Did you experience reduced exercise capacity, difficulty breathing once you started Chemotherapy?
– Did you get reviewed by a specialist, have an echocardiogram (ultrasound of the heart), or lung tests?
–> Who was the specialist?
–> Where were the tests done?
–> Have these symptoms resolved?
CREDIT – Dr Chris McMahon
Request
14. Change the smoking / drinking question
By default, the smoking and drinking question is a single question where the patient can answer Yes / No combinations and then a box can pop up asking how much in an average week.
Some members split this question into two separate questions (see 15. below for advanced changes)
Example (adults only): Do you smoke?
Example (adults only): Do you drink alcohol?
If Yes = How much did you smoke in the last week? / How much did you drink in the last week?
Request15. Extra smoking questions (incl child environment)
By default, children are not asked if they smoke, however some anaesthetists ask if anyone in the home/car environment smokes and then if they are an adult they can also ask if they smoke. However if they are a child a warning is shown and if they are an adult more questions are asked (see 16. below for warnings)
Example (adults only): Have you ever smoked cigarettes or other?
Example (all): Does anyone smoke in your home/car environment?
If yes is selected:
Do you currently smoke?
If Yes = How much did you smoke in the last week?
If No = How much did you smoke in the past?
– When did you give up?
– Have you smoked at all since then?
CREDIT – Dr Anna Pedersen, Dr Chris McMahon & others
Request16. Smoking warning
Show a warning message for a child or a separate message for an adult if the smoking question (see directly above) is selected
Example (Child): Children should not be exposed to smoke for at least 48 hours prior and for 3 days after the procedure. There is correlation for children exposed to smoke to be at greater risk of respiratory complications during and after the procedure.
Example (Adult – if they smoke): The knowledge from international research suggests that not smoking for a time prior (48hrs) to your operation results in significant change in the intraoperative and post-operative course of lung complications.
CREDIT – Dr Chris McMahon
Request
17. Recreational substances question and warning
This question can only be shown if the age is greater than 16.
If Yes is selected another question / details box can appear. A warning message can also be displayed
Example: Do you use recreational substances?
If Yes selected = Please included details like when and what did you last use?
A Warning box can also display:
It is important to avoid recreational substances, at least in the week prior to your operation
CREDIT – Dr Chris McMahon
Request
18. Medications list plus upload letter
The default medications paragraph box can instead appear as a list / column format asking patients to separate the information. They can also upload an image of a GP letter (as many include the medications on it already).
This question can only show for those that select Yes to taking medications
Example: If you have a medication list from your GP please upload it here, Alternatively, please detail each medication (or any other medications you take) with the strength taken and how often you take it
Request19. Medications warning box
Show a box directly above the medications question warning patients they may need to cease medications
Example: Please check with your surgeon if you are required to cease medications which increase bleeding eg. (not limited to) Clopidogrel, apixaban, warfarin.
CREDIT – Dr Chris McMahon
Request
20. Medications / surgeon question
Ask the patient if they have had any advice from the surgeon on which medication to cease plus even display another warning message
Example: What medication has your surgeon advised you to cease? (Please also include details on when your surgeon has advised you to take the last dose of that medication.)
Plus a warning box: Please note that you may receive advice from me that requires you to not take other medication the day of or day prior to your operation.
CREDIT – Dr Chris McMahon
Request
21. Non-prescription medications question
Ask the patient if there are any other non-prescribed medications they take.
If Yes is selected, a detail / paragraph box can appear where the patient can provide more information
Also if Yes is selected, a warning message can show
Example: Do you take regular non-prescribed medications? (this includes all herbs and vitamins like Gingko, Echinacea etc.)
If Yes is selected = Please detail each with the amount taken and how often you take it
Also show a warning box if Yes is selected = Please cease all non-prescribed medications for at least a week prior to your operation due to the effect they have on bleeding
CREDIT – Dr Chris McMahon
Request
22. Recent blood test question
Ask all patients if they have had a recent blood test, or only ask those that meet your requirements (e.g are on medications, have selected yes to certain health problems).
If Yes is selected, we can list your local blood test companies as a checkbox list for the patient to select, including an ‘other’ free space option.
Example: Have you had blood tests done recently? then Please select who the blood test company was..
CREDIT – Dr Chris McMahon
Request
23. Liver condition question
The default questionnaire asks many questions about other problems (lunch, diabetes, GORD, Thyroid, Neurological etc). Some members have also chosen to add a Liver question
Example: Liver condition? (Under the section ‘Do you have, or have you ever had, any of the following?’)
If Yes is selected = Please provide details (make sure you include your Hepatologist, Gastroenterologist or Liver Doctor’s name and contact details if applicable)
Request
24. Include gastric band surgery in GORD question
Add gastric band to the default GORD question and also include it as a separate option.
Currently the GORD question by default asks if the patient has “Gastro-oesophageal reflux disease (GORD), gastritis, oesophagitis, stomach or duodenal ulcers, hiatus hernia?”
Then if Yes is selected, usually 4 checkboxes appear regarding the burning sensation, we can also add gastric band to this
Example: Gastro-oesophageal reflux disease (GORD), gastritis, oesophagitis, stomach or duodenal ulcers, hiatus hernia, or have you had gastric band surgery?
If Yes is selected, an extra option appears = I’ve had a gastric band or gastric sleeve surgery
CREDIT – Dr Anna Pedersen
Request
25. Shortness of breath question change
By default there are usually only two options to the “Shortness of breath climbing less than 2 flights of stairs or whilst walking for 30 minutes on flat ground?” question – Yes and No.
This question is asked of all ages.
We’ve had feedback from a few patients recommending we add an “other” option to this (e.g for a paraplegic or for a baby that hasn’t learnt to walk yet). This “other” option can be a free form text box where the patient can elaborate.
Request26. Obstructive sleep apnoea questions
Instead of the standard “Any trouble with your lungs or respiratory system? (this could include asthma, obstructive sleep apnoea (OSA) with or without CPAP mask use, or smoking-related problems)” some members ask about OSA (and asthma – see 27. below) separately before this question, plus include a warning
Example: Do you have known Obstructive sleep apnoea (OSA)?
– Were you recommended to use a CPAP machine?
If Yes is selected we can say “Do you own a CPAP machine?” and even show a note or warning message “Please bring your CPAP mask with you to hospital as it may to assist your recovery from general anaesthesia”
Then the lung question is changed to add ‘other’: “Any other trouble with your lungs or respiratory system?”
CREDIT – Dr Anna Pedersen
Request
27. Extra asthma questions
By default asthma is asked in the lung question. If Yes is answered then a paragraph box usually appears. Some members instead ask separately about OSA (see 26. above) and asthma. Alternatively the lung question options Yes / No can just be changed to multiple choice options:
Example: Yes – Asthma
Yes – Obstructive Sleep Apnoea (OSA)
Yes – Other lung trouble
No
If the patient answers Yes to asthma, other questions and options appear
Example: Select all that apply
– A full canister of my reliever puffer (eg. Ventolin) lasts less than a month
– I wake up during the night because I need to use my reliever puffer (eg. Ventolin)
– I have required oral steroid tablets / liquid (eg. prednisone or prednisolone) to treat my asthma within the last 3 months
– I have previously been admitted to Intensive Care because of my asthma
– Anti-inflammatory medicines (eg. Nurofen, Voltaren, Mobic or Celebrex) provoke or make my asthma worse
– None of the above options apply to me
Or other questions could appear:
Have you ever had an ‘asthma attack’?
If Yes = How often have you had an ‘asthma attack’ and when most recently?
Have you ever been to hospital because of asthma?
If Yes = When was the most recent time and have you ever been you admitted overnight to hospital because of asthma?
CREDIT – Dr Anna Pedersen & other members
Request
28. Pregnancy question
Our very first questionnaire, which some of our original members are based on, only asked a yes / no option for pregnancy. An extra question could be added asking how many weeks (if yes is selected)
Example: If you are pregnant, how many weeks are you / would you be today?
Request29. Extra page uploads
Our very first questionnaire, which some of our original members are based on, only offered the upload of one single file. You are now able to offer multiple file uploads
Request30. Risk question
Ask patients to confirm they have read your information on the risks of anaesthesia.
Provide us with a document that details the risks – We can then upload this to your Extra Pages.
Patients can either be asked if they have read the document (yes / no) or we can also upload the risks to a scrolling box that they can (or must) tick to confirm they have read the risks
Example: Have you read the risks of anaesthesia section on my FAQ page? (please see Dr xxx FAQ page for this information. I would encourage you to ask me any specific questions that you may have) – Yes / No option
Example: (risks document also in a scrolling box): I have read and accept the above risks
CREDIT – Dr Anna Pedersen
Request
31. Estimate of fees / IFC question basic changes
By default the form asks the patient if they would like a quote or estimate with the options;
“Yes”, “No” or “N/A – I have already paid” (which then asks for details of how paid)
There are many ways you can change these options to suit your needs
Example: (change the question to) If you haven’t already been contacted by our staff, would you like an estimate of the Anaesthetic Fee pre-operatively? Plus the options;
* I have already been given an estimate of fees
* Yes – Please send me an estimate
* No – I’m happy to proceed as is
* Not required as I am being fully covered by a Workers Compensation / Defence Force / Third Party Insurance scheme
Example: (remove the question and instead display a note) Your surgeon has advised that you should call the office of on XXX and request a quote.
Request32. Estimate of fees / IFC question advanced changes
Our form is built so that we can provide you complete customisation – for example if there is a common procedure you always No Gap, or if there is a procedure you always No Gap but only with a particular surgeon and/or only at a particular hospital, we can base different values or even options to this question based on your criteria.
We can either show what the fee would be, do a range or simply given the fee option.
Example: only if Endoscopy and/or Colonoscopy is written as the procedure, we can show the option:
N/A – Endoscopy / Colonoscopy (No Additional Fee)
Example: (if Northern Beaches Hospital is written as the hospital and the procedure is X / surgeon is Y), we could even show the option:
N/A – I am a public patient
CREDIT – Dr Anna Pedersen
Request
33. Estimate of fees / IFC automated request
If you have a billing secretary that provides quotes to patients, we can create a notification to go to your billing secretary with the patient’s basic (not health specific) details.
Example: (if patient selects yes) Yes – Please send me an estimate
Request
34. Medicare and My Health Record
The question “Are you entitled to access Medicare..” exists in the Standard questionnaire however by default we don’t ask the Medicare number. To access a patient’s My Health Record you many need the patients Medicare number – we can add this question if required, and only for those that mark they have a My Health Record.
Example: Are you entitled to access Medicare..
If Yes – Do you have a My Health Record?
If Yes – Please provide your Medicare number
CREDIT – Dr Anand Thilla
Request
35. Display your Direct Deposit / EFT details
When the patient is asked if they would like a quote, it usually then asks them how they would like to pay, with Direct Deposit as an option. For patient’s who select Direct Deposit as the payment method, we can include your payment details underneath and/or on the confirmation page and/or in the confirmation email they receive
Example: Payment Details:
– Direct Deposit:
BSB xxx
Act xxx
Request36. Someone to Collect question change
The Standard questionnaire asks “Do you have someone to collect you from hospital and who can help you for the first 24 hours after discharge?” Some anaesthetists have changed the wording of this, or even displayed different warning messages.
Example: Do you have a responsible adult who can collect …
If the patient selects No, display a note: Please note: In order to go ahead with your procedure you must have a responsible adult collect you and stay with you. Please make arrangements for this now.
Or, if the patient is 18+, display the note: For the 24 hours after your anaesthetic, we advise that you do not drive, sign important documents or undertake activities where coordination is required.
Or, if the patient is <18, display the note: For the 24 hours after the anaesthetic, we advise children should avoid activities where coordination is required. This may include, but not limited to, avoiding climbing, bike riding, swimming, horse riding, gymnastics, etc.
Request37. Add other alerts
We can display any alert you require either as a standard alert (shown to all) or a smart alert (only shown to those that follow your criteria e.g medication name listed, previous anaesthetic problems marked yes, over a certain age etc)
Example: If your surgery is complex in nature or you have health concerns which require multiple medications or visits to the specialist in the last 6 months, the practice secretary may advise you that they will get back to you after Dr XXX has discussed your case with your surgeon.
CREDIT – Dr Chris McMahon
Request38. Change confirmation message
We can completely customise the confirmation messages patients are shown when their form is submitted
Example: If the patient mentions a certain procedure and/or surgeon, we can show them a different confirmation message (and patient confirmation email) or send them a link to your document on that procedure (e.g eye surgery).
Request39. Add ANZCA info documents
ANZCA have created a range of anaesthesia documents for patients (link here). We have received written permission from ANZCA to link these documents to your forms and profile pages. Please let us know which documents you would like included. We can even show the patient different documents based on their age / procedure / surgeon.
Example: If the patient is under 18, we can show the confirmation message and email the link to the Anaesthesia and Children ANZCA document
CREDIT – Dr Anna Pedersen
Request
40. Change default profile image to a list of hospitals
If you don’t have a profile image available, instead of a default graphic we can create you an image showing your list of hospitals. Just contact us with the information you would like and we can create it for you in the below style.
Example:
Request
41. Patient review form before submit
Add the ability for patients to review the information before they hit submit. On the review page they can check their answers and also print out a copy of their responses before submitting the form
Example: Would you like to review your answers before submitting the form?
Request42. Snoring Question
Add a snoring question
Example: Do you ever snore?
With the options: Yes, No, Not Sure
CREDIT – Dr Anna Pedersen
Request
43. Add other excessive bleeding descriptions
Adjust the blood clot and excessive bleeding description to mention other conditions. By default the description says ‘(this could include deep vein thrombosis (DVT), pulmonary embolism (PE), haemophilia or another condition)’
Example: Do you have a history of blood clots or excessive bleeding or any condition that may increase your risk of these? (eg. deep vein thrombosis (DVT), pulmonary embolism (PE), haemophilia, thalassaemia, von Willebrand and others)
CREDIT – Dr Anna Pedersen
Request
44. Non-Binary Gender
Instead of just Male and Female, we can also include a Non-Binary gender option
Example: add the words “Non-Binary” to the gender options
CREDIT – Dr Anna Pedersen
Request
45. Change notification message
We can completely customise the notification you receive
Example: If the patient mentions they have had certain anaesthetic problems before or select they have OSA, the notification you receive can have “HIGH RISK” or even “OSA – OVERNIGHT” in the subject line or any other notes at the top of the notification
Request
46. Anaesthetic problems – warning message & examples
Ask specifically if they have had problems, add a warning box asking the patient to ensure they mention any problems plus mention example complications in the details question.
Original questionnaires asked about anaesthetic problems as well as other issues in the question description and wasn’t as obvious to some patients.
Example: Have you ever had any anaesthetic complications or problems?
Plus a warning box: Warning Box: If you have ever had any reactions to or issues with receiving anaesthesia in the past, please ensure you detail this below
Then update the description to: Please list the details of your past surgical procedures, in particular if you have undergone a lap band (laparoscopic gastric banding) procedure. If you have ever had any anaesthetic problems or anaesthetic complications (eg. severe nausea/vomiting, perioperative cardiac events etc) please ensure you mention them here including the name of the hospital(s). Providing these details can help in retrieving previous anaesthetic records meaning past problems could potentially be avoided
Request
———————————————-Request a change
If you’d like to make a change or for more information – simply reply to one of our emails, call us or fill in the form above. Or for more information on what’s included in the Premium Plan please click here.
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