Joint Surgeons in Germany

Gelenk Klinik Orthopaedic Clinic
Alte Bundesstrasse 58
D-79194 Gundelfingen
fon: +49-761-79117-228
fax: +49-761-79117-999

Medical Questionnaire in Preparation for Anaesthesia

General Anaesthesia Combines Safety with Stress ReductionGeneral Anaesthesia Combines Safety with Stress Reduction ©Viewmedica

This questionnaire is for patients planning orthopaedic surgery at the Gelenk-Klinik Hospital in Germany. Please complete the form once you have requested a surgical appointment at our clinic.

Why is it important to complete this form?

Every anaesthetic procedure can have risks and side effects. The safety and comfort of our patients are our highest concern. The duty of the anaesthetist is to keep you safe at all times during your orthopaedic procedure.

In order to be able to avoid risks, it is important that you answer the questions below. If following this questionnaire, further information is required from you, the anaesthetist will contact you with further questions.

The anaesthetist will make recommendations in preparation for your procedure. A thorough and diligent follow-up to this questionnaire increases your safety and is important for the positive outcome of your procedure.

If you have any concerns about the private nature of any of the questions below, you may choose to postpone this interview until you arrive in our clinic (if this is the case, please tell us, so that this can be noted on your file).

(cardiac pacemakers, prostheses, stents, hormone coils, piercings)
(Cold, stomach infection, bowel infection etc)
(Medication for heart, pain, sleeping, anti coagulants, antidiabetes, psychopharmaceuticals or other preparations that you buy over the counter in your pharmacy)
(Genetic disposition, weakness, please also indicate if your blood relatives have such a condition)
(Please indicate accidents, job related health risks, severe injuries, allergies)

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Orthopaedic Clinic Germany

orthopedic clinic and surgeon in Germany

MVZ Gelenk-Klinik
Orthopaedic Clinic

ISO 9001:2015 certified quality

Alte Bundesstrasse 58

D-79194 Gundelfingen



360° Virtual Tour

3-D View of Gelenk-Klinik Praxis on Google Maps

Map and Route

Location of Gelenk-Klinik Gundelfingen
View Details of the location
  • Distance to EURO-Airport Basel: 80 km (45 mins)
  • Distance to Zurich: 161 km (1h 40)
  • Distance to Frankfurt: 259 km (2h 20)

Centre for Arthroplasty

Center of Excellence in Arthroplasty

Certified Centre for Arthroplasty (Centre for Endoprosthesis)