Pre-op Form

Complete this form if you will be undergoing a procedure and consent to Anaesthesia. This form is required to fulfill the criteria for surgery. All information is sought to minimise your risk and will be retained by the Anaesthetist as part of your confidential clinical record.

Please answer all questions as accurately as possible.

If for any reason this online form isn’t working for you,

Please download the below form, fill it out, and send it to: reception@epsomanaesthesia.co.nz