General Surgery Questionnaire

Secure form

This questionnaire helps the practice understand your surgical concern, symptoms and relevant health history before your appointment.

Full name Date of birth Email Phone Postcode

What condition or concern are you seeing us about? How long has this been present? Are you experiencing pain? Any recent worsening or urgent changes?

Previous surgery Medical conditions Current medications Allergies

Do you have a GP referral? Have you had scans, pathology or specialist reports? Anything else you would like Dr Mastakov to know?

If your symptoms are urgent or changing, call the practice or seek urgent medical care.