Pre-Anaesthetic Assessment

Pre-Anaesthetic Assessment is a vital part of any surgical procedure. The Anaesthetist evaluates your medical history, discusses any medications or allergies you may have, and reviews your past experience with anaesthesia. This pre-anaesthetic assessment will help the Anaesthetist determine how to ensure you have a safe, successful surgery.

Are you an Anaesthetist?

See how we can help you improve efficiency and optimise patient outcomes with a secure online preoperative assessment form. Try a Demo here

Background:
In the old days, pre-anaesthetic assessments were done on the day of surgery when the Anaesthetist asked you about your health just moments before the operation. Or you may have even been called the night before, or asked to attend a pre-anaesthetic assessment clinic. All of this was inconvenient and did not provide the patient with a good service.

Progressive Anaesthetists have taken pre-anaesthetic assessment to a new level by offering patients the option of completing a pre-anaesthetic assessment form online. In addition to providing convenience and accessibility for patients (particularly those who struggle with mobility issues or scheduling conflicts), online pre-anaesthetic assessment streamlines the assessment process so that the patient’s medical history and concerns can be examined in greater detail, promoting a more efficient, less stressful admission and procedure.

What do you need to do:
Please take your time to carefully review and answer the questions below. As a result, you will be less likely to miss any critical information and your Anaesthetist will have a more comprehensive understanding of your medical history and special needs. You will also have the opportunity to ask questions and clarify any concerns that you may have prior to your procedure.

If your Anaesthetist’s name does not show below, please visit this page to find your Anaesthetist. Each Anaesthetist has their own pre-anaesthetic assessment form.

Are you an Anaesthetist?

See how we can help you improve efficiency and optimise patient outcomes with a secure online preoperative assessment form. Try a Demo here

Pre-Anaesthetic Assessment Form

"*" indicates required fields

Step 1 of 5 – Please complete the Patient and Operation Details below:

Please note: This form can be completed from ANY device

If you would rather complete this on a bigger screen, please click ‘Save Your Form’ below or visit anaestheticgroup.com.au from your desktop or laptop

You will often be asked to complete a similar questionnaire by the hospital before admission for their own records – this is not provided to your Anaesthetist. To ensure your Anaesthetist is properly prepared for your anaesthetic, please complete this pre-op health questionnaire to the best of your ability.

This questionnaire should take approximately 18 minutes to complete. We strongly recommend you click the “Save Your Form” button at the bottom of every page whenever you need to step away to check information (this form is designed to timeout after inactivity for security and privacy reasons), or if your internet connection is unstable.

You can complete your questionnaire faster if you have the following ready:
– Details of your current medications, weight (kg) & height (cm)
– Information about your health conditions and previous procedures
– Your health care cards (Medicare card, private health fund etc)
– Contact details of your usual Doctors (GP & Specialists)
– A scanned PDF or JPG of any results, medications or letters you wish to send your Anaesthetist

Tips:
* To return to a previous page, only click the “PREVIOUS” button
* Some fields are mandatory and marked with an asterisk (*)
* When you click “Save Your Form“, your entered data will not be lost if you leave your device. You will also see a unique link that can be clicked, copied or emailed. The link can also be used on a different device (eg. for taking pictures from your phone or checking dates, heights, or weights).
* You can send extra files to your Anaesthetist later via the contact form on their profile page
* To provide additional information or ask questions to your Anaesthetist, click YES to the final question “Is there anything else you would like to mention?”.

🔒 This is a secure form. Once you submit this form, it is immediately sent to your Anaesthetist and for added security Anaesthetic Group does not store your completed questionnaire.

STOP! PLEASE DO NOT FILL IN THIS FORM.

Please click the Pre-Op form link only on your Anaesthetist’s page
(or visit anaestheticgroup.com.au to search for your Anaesthetist) to complete their form.
If you see this warning and fill in this form it will not be sent to your Anaesthetist.
This form will only reach your Anaesthetist when you click the link on their page.

The Anaesthetist selected is:*

Patient Details:

Patient's Name*

First Last

Are you the patient?*

Yes

Your Name

Relationship to Patient

Please complete all of the following questions based on the patient
ie. when the question refers to “you” please describe the patient’s health.

Gender*

Female

Male

Other

What were you assigned at birth?

Female

Male

What do you identify with now?

Phone Number(s)*

Please check your email address – You entered “.con” but normally it’s “.com“
To receive confirmation of your submission, you must enter a valid email address. (However, if your email address really does contain a “.con” inside it, please disregard this message).

Date of Birth*

(select your date of birth using the calendar icon or enter it as dd/mm/yyyy eg. 01/05/1981)

In case you are a parent filling in the form for your child, please make sure you enter your child’s date of birth and not your own

Hidden

Age (Hidden – auto calculated)

Operation Details:

Surgeon*

Hospital

Operation*

(the procedure being performed)

Date of Operation

(select the operation date using the calendar icon or enter it as dd/mm/yyyy eg. 01/12/2024)

Why are you having this operation?

(what symptoms or diagnosis made you decide to undergo this procedure?)

Stop!! You have entered the wrong Date of BIRTH above.
The age we calculated for you is “0” years old. Please scroll up and correct the “Date of Birth” entered.

However, if this form is for a baby, please scroll up and fix the second question, as you answered it incorrectly.

Or, please tick the box below to confirm the date of birth is correct*

I confirm my date of birth above is correct and this form is being filled in for a baby

Pre-Anaesthetic Assessment

Pre-Anaesthetic Assessment Form

Patient Details:

Operation Details:

Patient Details:

Do you have, or have you ever had, any of the following?

File Upload

Other Details:

PATIENTS

SURGEONS

ANAESTHETISTS