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Medical Questionnaire / History

Please fulfill this questionnaire, as you are planning operation with us! (These informations a confidential, we don't give anybody else.)

General Health Problems
Blood Disorders
Coronary
Have you ever get transplant-blood?
Do you use anti-coagulants?
Skin Diseases/Disorders
Steroids-topical or oral?
Roaccutane use within last 12 months?
Pregnant/Planning Pregnancy?
How many children do you have?
Contraceptive Pill?
Dermal fillers
Skin bruises easily?
Suffer from depression/anxiety?
Semi-permanent make-up
Do you Smoke?
Do you wear contact lenses?
Have you been on prescribed antibiotics in the last month?
Is there any history of Breast cancer in the family?
Have you ever had a Mammogram?
Do you exercise regularly?
Do you follow a healthy diet?
Are you planning a holiday in the sun?

 
Home   |   About Our Clinic   |   Meet Dr Kovacs Annamaria   |   Contact Us
Breast Procedures   |   Body Procedures   |   Facial Surgery   |   Non-Surgical
Gallery   |   Media   |   Travel and Accommodations   |   Patient Pre/Post-Operative Care  .