Questionnaire Preoperative examination, Child

The purpose of this questionnaire is to get detailed information about the health of your child. We therefore ask you to answer the following questions honestly. Please fill in the complete questionnaire. This will help to keep the preoperative examination short.

This questionnaire will be sent via an encrypted email. This way we can protect the privacy of sensitive information.

Questionnaire

11. Does (or did) your child suffer from one of the following diseases?

The following questions are only for parents of children that are younger than one year: