Liposuction Pre-Op QPROM

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

The questionnaire should only be completed by patients who are due to have liposuction and it will only take a few minutes.

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Date of brith
What part of your body will you have liposuction on? (check all that apply)

With your Entire Body in mind, in the past week, how dissatisfied or satisfied have you been with:

1. How your body looks when dressed?
2. How your clothes fits your body?
3. The size of your body (i.e. weight)?
4. The shape of the body?
5. How your body looks in photos?
6. How your body looks from behind?
7. How your body looks from the side (ie side profile)?
8. How your body looks in summer clothes (e.g., shorts, t-shirts)?
9. How your body looks in a swimsuit?
10. How your body looks in the mirror unclothed?