Eyelid Surgery Pre-Op QPROM

Thank you for choosing to have your eyelid surgery at Kinvara Private Hospital. Please complete this short questionnaire (known as a Quality Patient-Reported Outcome Measure – QPROM).

The questionnaire should only be completed by patients due to undergo eyelid surgery and will only take a few minutes.

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Name
Date of birth
Which eyelids are you having surgery on?

Answer the questions with how dissatisfied or satisfied have you been with your eyes, in the past week

1. How nice your eyes look?
2. The shape of your eyes
3. How open your eyes look
4. How alert (not tired) your eyes look?
5. How bright eyed you look?
6. How attractive your eyes look?
7. How youthful your eyes look?