+44 758 720 53 06
+44 758 720 53 06
Home
Treatments
Doctors
Health Guide
Direct Flight To Izmir
Contact Us
English
Deutsch
Русский
Italiano
Presurgery Anamnesis
Presurgery Anamnesis
Name Surname
Your E-Mail Address
Your E-Mail Address
Gender
Female
Male
Gender Neutral
Prefer Not To Say
Date of Birth (DD/MM/YYYY)
Weight (Specify Measurement Unit)
Height (Specify Measurement Unit)
BMI
Any medical conditions you have?
No
Yes
Have you ever had a blood transfusion?
No
Yes
Any cosmetic surgeries you have had?
No
Yes
Any medications you have had?
No
Yes
Do you have any blood or blood clotting disorders?
No
Yes
Depression, anxiety etc. have you been diagnosed?
No
Yes
Do you smoke?
No
Yes
Weekly alcohol intake?
I don't intake alcohol
1-2 Days
2-5 Days
Everyday
Any immune system disorders?
No
Yes
Any type of cancer, including skin cancer?
No
Yes
Do you take any anticoagulants (Aspirin,Coumadin,etc.)?
No
Yes
Do you require preventive antibiotics?
No
Yes
Do you have prescription, non-prescription or supplements that you are currently taking?
No
Yes
Are you allergic to adhesive or tape?
No
Yes
Are you allergic to Latex or Latex products?
No
Yes
Do you consume any form of recreational drugs or preparations?
No
Yes
Do you have a medication allergie? (Penicillin, Lidocaine etc)
No
Yes
Do you have any food allergies?
No
Yes
Do you have lenses or any implants?
No
Yes
Do you suffer from sleep apnea?
No
Yes
Do you take Fish Oil and or Vitamin E?
No
Yes
Do you have any trouble swallowing tablets?
No
Yes
Have you had outbreaks of oral herpes?
No
Yes
Have you had any problems with anesthesia?
No
Yes
Have you ever had blood clots?
No
Yes
Have you ever had a pulmonary embolism?
No
Yes
Do you have respiratory problems? (Asthma etc.)
No
Yes
Do you have cardiovascular problems? (Heart attack, angina etc.)
No
Yes
Do you have metabolic problems? (Thyroid disease or diabetes)
No
Yes
Do you have anaemia problems? (Nosebleeds, easy bruising etc.)
No
Yes
Do you take Ibuprofen?
No
Yes
Do you take Aspirin? (Stop 5 days pre-surgery)
No
Yes
Are you HIV positive?
No
Yes
Are you Hepatitis B positive?
No
Yes
Are you Hepatitis C positive?
No
Yes
Have you ever had MRSA?
No
Yes
Write your message
I agree to the
Terms & Conditions
!