As with any medical surgery—whether surgical or non-surgical—prior to undergoing plastic surgery Turkey or hair transplantation, it’s essential to gather basic information about your health. Medical background check is a form designed to thoroughly assess your unique medical condition—and to assure that your procedure is conducted with the ultimate in safety, comfort and effectiveness. Our doctors are trained in the latest techniques and state-of-the-art innovations in the field of plastic surgery and hair transplantation.

First Name (required)

Last Name (required)

Date of Birth (required) day/month/year

Your Email (required)

Home Address (required)

Do you take Allergies medication? (required)
 Yes No

Have you had any infectious diseases or porter of a viral infection?
( HBsAg, HIV, HCV, etc) (required)
 Yes No

Do you take Anaemia medication? (required)
 Yes No

Do you take Asthma medication? (required)
 Yes No

Do you take Birth control - The pill? (required)
 Yes No

Please indicate your Blood pressure level (required)
 High Normal Low

Do you have Deep Vein Thrombosis/ Blood Clots? (required)
 Yes No

Do you use Depression medication? (required)
 Yes No

Do you have Diabetes? (required)
 Yes No

Please describe Current and prescribed Medication you are taking

Past Medical History that needs mention

Do you drink or smoke?

How many cigarettes do you smoke per day?

Have you or your family ever had difficulties with General Anaesthetic?
 Yes No

Do you have any known heart problems?
 Yes No

Have you ever been jaundiced?
 Yes No

Are you able to carry out physical activities?
 Yes No

Have you had any previous surgery ? If so for what operation and when ?
 Yes No

Do you wish to mention anything special?

Please read terms and conditions: Yes