surgeo-and-safari

 

 

 

STEP BY STEP GUIDE

CLIENT COMMENTS

PUBLICITY

 

"That is probably everybody's reaction who has had the opportunity of spending time in your care, but for me it was more than just a successful medical procedure (which it definitely was) but the opportunity for a meaningful friendship to develop."

With much love, Jeri

Informed Choice - Questions you need to ask yourself

  • Are you able to use extended forms of communication like Email, Telephone and communicate with Past clients?
  • Have you asked questions, raised your concerns and fears?
  • How do you feel about how the Surgeon has addressed your questions?
  • Has your communication been open and honest?
  • Are you sure that you have realistic expectations?
  • Have you been made aware of the benefits and risks involved?

 

Name
Surname
Date of Birth
Weight and Height
W
H
Postal Address
Country
Telephone
Fax
Email Address
Occupation
Hobbies and Interests and sport
Selected Surgical Procedure
Why are you considering this procedure?
If you are currently consulting a Psychiatrist or Psychologist Have you discussed your intention of having the above mentioned surgery Yes No
Have you ever been treated for psychiatric illness? This includes depression.
If so, what treatment have you been on in terms of anti-depressants, sleeping tablets, anxiolytics (anti anxiety)
How long have you been taking this treatment?
Yes No
Would it be possible to get a comprehensive report from your physician/psychiatrist in terms of your condition?
Yes No
Have you suffered from previous deep vein thrombosis, i.e. blood clots, developing in the leg following long air flights, long hospital stays, etc?
If so, when was this and what treatment were you prescribed and for how long
Yes No
Have you ever abused drugs or any substance?
If so, What and for how long and when did you stop.
Yes No
Current and prescribed Medication you are taking
Past Medical History that needs mention
Allergies
What are your concerns, worries and fear about having this  procedure
What is it that you do not like about yourself?
- Please explain
Have you consulted a surgeon for this procedure? If so, what was the plastic surgeon name and what was his plan of operation?
Do you drink or smoke? Give Details
Yes No
Cigarettes / Day
Drinks / Day
Have you or your family ever had difficulties with General Anaesthetic? If so, please advise of any complications.
Yes No
Are you prone to KELIODS or poor scaring?
Yes No
Have you ever been ANAEMIC? If so, how was it treated and have you ever had a Blood Transfusion?
Yes No
If a blood transfusion should be necessary, would there be any reasons at all why you would refuse it?
Do you have ASTHMA or LUNG DISEASE?
ASTHMA Yes No
LUNG DISEASE Yes No
Do you have HIGH BLOOD PRESSURE? If so, what treatment are you taking and are you well controlled?
Yes No
Do you have any known HEART problems?
Yes No
Have you ever been JAUNDICED?
Yes No
Are you on the "PILL" or any other HORMONE?
Yes No
Do you or any relatives have DIABETES? If so, please specify
Yes No
Please name the surgeon you have selected
When would you consider travelling to South Africa?
Would you like to correspond with past clients?
Yes No
Would you like to have a consultation in London
Please look at the London consultation calendar
Yes No
If YES, specify the dates for the London consultation
IT IS IMPORTANT TO READ OUR TERMS AND CONDITIONS BELOW

I have read the terms and conditions above:
Yes No
After sending this form we request that you also send us a close up photograph of the body area you are requesting the procedure for. This will assist further medical evaluation by the surgeon.
Enter Text Shown in Picture Below:

Please be assured that all electronic data received is treated with the strictest confidentiality.

Any medical or surgical advice provided through this web site service, even if intended to be accurate to the best of our knowledge, should be discussed with the surgeon before embarking on any treatment, medication or therapy.



 

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