Skip to content
About Us
Hair Transplant
Sapphire FUE Hair Transplant
DHI Hair Transplant
Beard Transplant
Eyebrow Transplant
Woman Hair Transplant
Hair Transplant Albania
Plastic Surgery
Brazilian Butt Lift (BBL)
Breast Enlargement
Breast Lift
Breast Reduction
Brow Lift
Eyelid Surgery
Facelift
Liposuction
Rhinoplasty (Nose Job)
Thigh Lift
Tummy Tuck
Dentistry
Dental Implant
Dental Veneers
Teeth Whitening
Zirconium Crowns
Weight Loss
Gastric Balloon
Gastric Band
Gastric Bypass
Mega Liposuction in Turkey
Sleeve Gastrectomy
Contact
Prices
Blog
Menu
About Us
Hair Transplant
Sapphire FUE Hair Transplant
DHI Hair Transplant
Beard Transplant
Eyebrow Transplant
Woman Hair Transplant
Hair Transplant Albania
Plastic Surgery
Brazilian Butt Lift (BBL)
Breast Enlargement
Breast Lift
Breast Reduction
Brow Lift
Eyelid Surgery
Facelift
Liposuction
Rhinoplasty (Nose Job)
Thigh Lift
Tummy Tuck
Dentistry
Dental Implant
Dental Veneers
Teeth Whitening
Zirconium Crowns
Weight Loss
Gastric Balloon
Gastric Band
Gastric Bypass
Mega Liposuction in Turkey
Sleeve Gastrectomy
Contact
Prices
Blog
About Us
Hair Transplant
Sapphire FUE Hair Transplant
DHI Hair Transplant
Beard Transplant
Eyebrow Transplant
Woman Hair Transplant
Hair Transplant Albania
Plastic Surgery
Brazilian Butt Lift (BBL)
Breast Enlargement
Breast Lift
Breast Reduction
Brow Lift
Eyelid Surgery
Facelift
Liposuction
Rhinoplasty (Nose Job)
Thigh Lift
Tummy Tuck
Dentistry
Dental Implant
Dental Veneers
Teeth Whitening
Zirconium Crowns
Weight Loss
Gastric Balloon
Gastric Band
Gastric Bypass
Mega Liposuction in Turkey
Sleeve Gastrectomy
Contact
Prices
Blog
Menu
About Us
Hair Transplant
Sapphire FUE Hair Transplant
DHI Hair Transplant
Beard Transplant
Eyebrow Transplant
Woman Hair Transplant
Hair Transplant Albania
Plastic Surgery
Brazilian Butt Lift (BBL)
Breast Enlargement
Breast Lift
Breast Reduction
Brow Lift
Eyelid Surgery
Facelift
Liposuction
Rhinoplasty (Nose Job)
Thigh Lift
Tummy Tuck
Dentistry
Dental Implant
Dental Veneers
Teeth Whitening
Zirconium Crowns
Weight Loss
Gastric Balloon
Gastric Band
Gastric Bypass
Mega Liposuction in Turkey
Sleeve Gastrectomy
Contact
Prices
Blog
Facebook
Instagram
Youtube
Search
Search
Close this search box.
Medical History
home
Medical History
happy-customer
Satisfied Clients
0
k+
Years of Experience
0
+
hair-care
Hair Transplants
0
k+
Patient Satisfaction Rate
0
%
Please enable JavaScript in your browser to complete this form.
Please enable JavaScript in your browser to complete this form.
Date
*
Name
*
First
Last
Treatment Type:
*
Age:
*
Height:
*
Weight:
List of medications you are currently using (ncluding over-the-counter medications):
List of surgeries you have performed before (including plastic surgeries):
Date
Surgical Intervention:
Use herbal supplements or vitamins (especially Gingko, ginger, garlic, St. John’s Wort, C, E, fish oil)?:
Medicines that cause allergies:
Are you a smoker?
YES
NO
If yes; For how long?
Are you an alcohol user?
YES
NO
If yes; what quantity?:
Do you have any of the following symptoms?
Chest pain:
YES
NO
Breast diseases:
YES
NO
Seizure:
YES
NO
Heart problems:
YES
NO
Thyroid problems:
YES
NO
Tooth problems:
YES
NO
High blood pressure:
YES
NO
Hepatitis C:
YES
NO
Emotional problems:
YES
NO
Diabetes:
YES
NO
Kidney problems:
YES
NO
HIV:
YES
NO
Cancer:
YES
NO
Asma:
YES
NO
Eye problems:
YES
NO
Problems with bleeding:
YES
NO
Submit
Let's Get In Touch
+90 501 007 0686
[email protected]