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?*
What day do you prefer to have your procedure? If you are a public patient please skip this question.
Do you have any questions or preferences?