{"id":2319,"date":"2025-04-23T09:35:53","date_gmt":"2025-04-23T09:35:53","guid":{"rendered":"https:\/\/riberacareinternational.com\/?page_id=2319"},"modified":"2025-04-23T11:52:23","modified_gmt":"2025-04-23T11:52:23","slug":"pre-anesthesia-questionnaire","status":"publish","type":"page","link":"https:\/\/riberacareinternational.com\/ru\/pre-anesthesia-questionnaire\/","title":{"rendered":"\u041e\u043f\u0440\u043e\u0441\u043d\u0438\u043a \u043f\u0435\u0440\u0435\u0434 \u0430\u043d\u0435\u0441\u0442\u0435\u0437\u0438\u0435\u0439"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"2319\" class=\"elementor elementor-2319\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-9621200 e-flex e-con-boxed e-con e-parent\" data-id=\"9621200\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-86c2177 e-con-full e-flex e-con e-child\" data-id=\"86c2177\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-e47027e elementor-widget elementor-widget-text-editor\" data-id=\"e47027e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\tFILL AND SEND THE FORM\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-250ad88 elementor-widget elementor-widget-heading\" data-id=\"250ad88\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Pre anesthesia questions<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-311d31e elementor-hidden-mobile elementor-widget elementor-widget-text-editor\" data-id=\"311d31e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\tIt is important that you complete and submit the pre-anesthesia form.\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-c808c67 e-flex e-con-boxed e-con e-parent\" data-id=\"c808c67\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-d64f248 e-con-full e-flex e-con e-child\" data-id=\"d64f248\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-294202f elementor-widget elementor-widget-heading\" data-id=\"294202f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Fill and send please<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c85a51d elementor-widget elementor-widget-text-editor\" data-id=\"c85a51d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\tOur team will evaluate each response.\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9ef75ce elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"9ef75ce\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;button_width&quot;:&quot;50&quot;,&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" id=\"footer_form\" name=\"footer-form\" aria-label=\"footer-form\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"2319\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"9ef75ce\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Ribera International\" \/>\n\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-name elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-name\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFirst Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[name]\" id=\"form-field-name\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Please enter your first name\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_2d75486 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_2d75486\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tLast Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_2d75486]\" id=\"form-field-field_2d75486\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Please enter your last name\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-email elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-email\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tEmail Address\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"name@email.com\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_a188c24 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a188c24\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPhone Number\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_a188c24]\" id=\"form-field-field_a188c24\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"+XXXXXXXXXX\" required=\"required\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"\u041f\u0440\u0438\u043d\u0438\u043c\u0430\u044e\u0442\u0441\u044f \u0442\u043e\u043b\u044c\u043a\u043e \u0446\u0438\u0444\u0440\u044b \u0438 \u0442\u0435\u043b\u0435\u0444\u043e\u043d\u043d\u044b\u0435 \u0441\u0438\u043c\u0432\u043e\u043b\u044b (#, -, * \u0438 \u0442. \u0434.).\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_07ab5a4 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_07ab5a4\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAge\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_07ab5a4]\" id=\"form-field-field_07ab5a4\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Please enter your age\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_bb635c6 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_bb635c6\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tBMI\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_bb635c6]\" id=\"form-field-field_bb635c6\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Please enter your BMI\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_7f77968 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_7f77968\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWeight (kg)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_7f77968]\" id=\"form-field-field_7f77968\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Please enter your weight\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_805d3a7 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_805d3a7\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHeight (m, cm)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_805d3a7]\" id=\"form-field-field_805d3a7\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Please enter your height\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_0bc366a elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_0bc366a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSex\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Male\" id=\"form-field-field_0bc366a-0\" name=\"form_fields[field_0bc366a]\" required=\"required\"> <label for=\"form-field-field_0bc366a-0\">Male<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Female\" id=\"form-field-field_0bc366a-1\" name=\"form_fields[field_0bc366a]\" required=\"required\"> <label for=\"form-field-field_0bc366a-1\">Female<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_7679d8f elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_7679d8f\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tReason for consultation\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_7679d8f]\" id=\"form-field-field_7679d8f\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Please enter your reason\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_fed8116 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_fed8116\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSigns and Symptoms\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_fed8116]\" id=\"form-field-field_fed8116\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Please enter your signs and symptoms\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_0f38ede elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_0f38ede\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHow long you have had the problem?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_0f38ede]\" id=\"form-field-field_0f38ede\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Please enter your response\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-upload elementor-field-group elementor-column elementor-field-group-field_2ef6af1 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_2ef6af1\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tLast medical report detailing the reason for the consultation:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input type=\"file\" name=\"form_fields[field_2ef6af1][]\" id=\"form-field-field_2ef6af1\" class=\"elementor-field elementor-size-sm  elementor-upload-field\" required=\"required\" multiple=\"multiple\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-upload elementor-field-group elementor-column elementor-field-group-field_b11b0ae elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b11b0ae\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tImaging tests:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input type=\"file\" name=\"form_fields[field_b11b0ae][]\" id=\"form-field-field_b11b0ae\" class=\"elementor-field elementor-size-sm  elementor-upload-field\" required=\"required\" multiple=\"multiple\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text\">\n\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_11d9015]\" id=\"form-field-field_11d9015\" class=\"elementor-field elementor-size-sm \" style=\"display:none !important;\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-acceptance elementor-field-group elementor-column elementor-field-group-field_77d9a51 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t<div class=\"elementor-field-subgroup\">\n\t\t\t<span class=\"elementor-field-option\">\n\t\t\t\t<input type=\"checkbox\" name=\"form_fields[field_77d9a51]\" id=\"form-field-field_77d9a51\" class=\"elementor-field elementor-size-sm  elementor-acceptance-field\" required=\"required\">\n\t\t\t\t<label for=\"form-field-field_77d9a51\">I have reade and agree to the <a href=\"https:\/\/riberacareinternational.com\/privacy-policy\/\">Privacy Policy<\/a>.<\/label>\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-acceptance elementor-field-group elementor-column elementor-field-group-field_e52cad1 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"elementor-field-subgroup\">\n\t\t\t<span class=\"elementor-field-option\">\n\t\t\t\t<input type=\"checkbox\" name=\"form_fields[field_e52cad1]\" id=\"form-field-field_e52cad1\" class=\"elementor-field elementor-size-sm  elementor-acceptance-field\">\n\t\t\t\t<label for=\"form-field-field_e52cad1\">I agree to receive communications from RIBERA SALUD, SAU, in order to learn about the latest health news<\/label>\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_0f136d9 elementor-col-100\">\n\t\t\t\t\tData Controller: RIBERA SALUD, SAU<br>\nPurpose: Manage information and contact requests and Manage user subscription to the newsletter.<br>\nRights: The patient may at any time exercise the rights of access, rectification, deletion, opposition, limitation and portability by following the indications included in the data protection policy.\n<br>More information: <a href=\"https:\/\/riberacareinternational.com\/privacy-policy\/\">here<\/a>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-hidden elementor-field-group elementor-column elementor-field-group-field_9ee6b0b elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"hidden\" name=\"form_fields[field_9ee6b0b]\" id=\"form-field-field_9ee6b0b\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-50 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-sm\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Send the form<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-e60fee1 e-con-full e-flex e-con e-child\" data-id=\"e60fee1\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-f254b70 elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"f254b70\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"mailto:info@riberacareinternational.com\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"44\" height=\"44\" viewBox=\"0 0 44 44\" fill=\"none\"><circle cx=\"22\" cy=\"22\" r=\"22\" fill=\"#D71029\"><\/circle><path d=\"M8.45503 30.5571L8.45536 30.5574C8.84294 30.9366 9.36726 31.15 9.91405 31.15H34.086C34.6327 31.15 35.1571 30.9366 35.5446 30.5574L35.545 30.5571C35.9314 30.1767 36.15 29.6608 36.15 29.1217V15.8783C36.15 14.7556 35.223 13.85 34.086 13.85H9.91405C8.77697 13.85 7.85 14.7556 7.85 15.8783V29.1217C7.85 29.6608 8.06856 30.1767 8.45503 30.5571ZM20.9896 22.4457L10.0349 14.6867H33.9648L23.0104 22.4457L23.0104 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Calle Mallorca, 25, Urbanizaci\u00f3n Do\u00f1a Pepa. 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