Preoperative Anaesthesia Assessment Questionnaire

Preoperative Anaesthesia Assessment (POA) Questionnaire

Preoperative Anaesthesia Assessment (POA) Questionnaire

Thank you for taking the time to complete this form ahead of your surgery.

My goal is to identify any concerns you may have and address any medical issues that may delay or prevent your surgery from being completed safely. Prompt return of this form will help coordinate any necessary investigations before your Anaesthetic Assessment.

Questions? Email me: Dr.stewart.southey@novocayman.com

Warm regards,
Dr Stewart Southey MBBCh FRCA MBA MSc

Filling in the Form

  • Be as accurate as possible. Your safety is our priority.
  • If an item doesn’t apply, leave it unchecked.

Personal Information