Get the free Breast reduction questionnaire - drhatfield.com

BREAST REDUCTION QUESTIONNAIRE Name: Date of birth: Today's date: Who has referred you here? How much do you currently weigh? Is your weight stable? No Yes Have you lost weight recently? No Yes How

How to fill out breast reduction questionnaire

Who needs a breast reduction questionnaire?

Patients considering breast reduction surgery: Women who are experiencing discomfort and pain due to their large breasts may be advised or considering undergoing breast reduction surgery. As part of the pre-operative evaluation, doctors commonly request patients to fill out a breast reduction questionnaire to gather essential information about the patient's medical history, symptoms, and expectations.

How to fill out a breast reduction questionnaire:

1. Begin by carefully reading each question: Take your time to read and understand each question in the questionnaire. It's important to provide accurate and detailed information to help your healthcare provider assess your condition properly.
2. Provide personal details: The questionnaire may ask for your personal details such as your name, age, contact information, and relevant medical history. Fill out these sections accurately to ensure proper identification and evaluation.
3. Describe your symptoms: The questionnaire will likely include questions about the symptoms you are experiencing due to your large breasts. This may include pain, discomfort, limitations in physical activities, and emotional impact. Be honest and specific when describing your symptoms to help your healthcare provider understand your unique situation.
4. Medical history: The questionnaire may require you to provide information about any previous surgeries or medical conditions you have had. This information helps in assessing your overall health and potential risks during the surgery.
5. Expectations and goals: You may be asked about your expectations and goals for undergoing breast reduction surgery. This is an opportunity to communicate your desired breast size, shape, and any specific concerns or aesthetic goals. It is essential to have realistic expectations and be clear about what you hope to achieve through the procedure.
6. Medications and allergies: The questionnaire may ask about any medications you are currently taking, including over-the-counter drugs and supplements, as well as any known allergies. This information helps your healthcare provider understand potential drug interactions and manage your care effectively.
7. Follow instructions: Pay attention to any specific instructions provided alongside the questionnaire. This may include completing the questionnaire by a certain deadline or attaching relevant medical records, scanned images, or photographs.

Remember, the breast reduction questionnaire serves as an important tool for your healthcare provider to gather information, understand your needs, and plan your surgery effectively. Providing accurate and detailed answers will contribute to a better understanding of your situation and help ensure a successful outcome.

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