Recall Please fill in the information below and we will be in contact with an appointment or procedure date.

 

Please fill in the information below and we will be in contact with an appointment or procedure date.


What was your recall for?*:


Have you had major chest pain or a heart attack within the past 3 months?*:


Have you had a stroke within the past 3 months?*


Do you have problems performing your daily chores or shopping without getting short of breath?*


Do you take blood-thinning medication such as any Aspirin preparation, Astrix, Cartia, Cardiprim, Plavix, Iscover, Persantin,
Asasantin or Warfarin because of heart valve replacement or a recent stroke or a heart attack?*


Are you older than 75?*


Are you diabetic requiring insulin or medications?*


Do you have any concerns about your fitness for a general anaesthetic?*


Do you have any concerns about the need for this procedure?*


Do you have a new referral from your GP? A valid referral must be sent to our rooms prior to arranging dates for this procedure*


Are you in a health fund with hospital cover or are you a public patient?*


Do you have any questions or preferences?