Health Questionnaire & Consent

You will receive a folder with important pre-asmission information including a Health Questionnaire and Consent Form.  This form assists the health team to plan your care and includes important questions about your personal and contact details, health history, consent for treatment, any special needs and payment arrangements.  

 

The information you provide about your health history is used to assess your health status.  It is important that you answer the questions in this form about your past and present health status as accurately and fully as possible. If any of the information changes before your admission, please notify the hospital immediately.

 

In some cases a preoperative assessment with the Anaesthetist will be required (Belverdale Hospital will arrange this if needed).

 

Please return your completed Health Questionnaire & Consent form to Belverdale Hospital as soon as possible or ideally at least seven (7) working days prior to surgery.

 

The Health Questionnaire & Consent form can be

  • delivered to Belverdale Hospital - 5 Campbell Street, Whanganui
  • emailed to reception@belverdale.co.nz  (please bring the original with you on admission)
  • faxed to 06) 3481183 (please bring the original with you on admission)
  • mailed to Belverdale Hospital, 5 Campbell Street, Wanganui 4500 (please post at least 7 days prior to surgery to allow for delays)

 

Failure to return this form within this timeframe may result in your surgery being postponed, as we may not have enough time to arrange additional assessments you may require.

Belverdale Hospital
Belverdale Hospital