Rhinoplasty (Nose Job) Pre-Op QPROM

Thank you for choosing Kinvara Private Hospital for your rhinoplasty. 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 rhinoplasty and will only take a few minutes.

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Name
Date of birth

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

1. The overall size of your nose?
2. How straight your nose looks?
3. How well your nose suits your face?
4. The length of your nose?
5. The width of your nose at the bottom (from nostril to nostril)?
6. How the bridge of your nose looks (where glasses sit)?
7. How the tip of your nose looks?
8. The shape of your nose in profile (side view)?
9. How your nose looks in photos?
10. How your nose looks from every angle?