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By what channel should we contact you? WhatsApp Phone Email
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Which Service Are You Interested In? e.g. Gastric Sleeve Gastric Sleeve Gastric Sleeve Gastric Bypass Plastic Surgeries (Face) Plastic Surgeries ( Body) Dental Hair Transplant
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Please list any other surgeries you have had and when you had them.
Please list any medical conditions you have (Sleep apnea,heart disease, hypertension, kidney disease, cancer, diabetes, hepatitis, seizures, depression, thyroid etc)
Do you use any medications regularly? Yes No
List the Medications You Use Regularly
Please list the medicines you are allergic to.
How many times have you been pregnant? None 1 2-3 More Than 3
Do you smoke regularly? Yes No
If you smoke, how many cigarettes do you smoke per day? 1-2 3-5 5-10 More than 10
How often you drink alcohol ? I don't drink alcohol I rarely drink alcohol I'm a social drinker I drink alcohol often
Are you coming with a friend or alone? With a friend Alone
Where did you hear about us ? Friend or Past Patient Instagram Facebook(Group) Google Search
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