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
Sport and hobbies
Specify Surgical Procedure
Why are you considering this procedure?
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 ever abused drugs or any substance?
If so, What and for how long and when did you stop.
Yes No
Current Prescribed and General Medication you are taking
Past Medical History that needs mention
Do you have any recent medical records
Yes No
If so, please give Doctor's name
Contact telephone no for this Doctor
Allergies
Do you drink or smoke? Give Details
Yes No
Cigarettes / Day
Drinks / Day
Do you have ASTHMA or LUNG DISEASE?
ASTHMA Yes No
LUNG DISEASE Yes No
Do you have HIGH BLOOD PRESSURE?
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?
Yes No
Specify a surgeon for new procedures to be done
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I have read the terms and conditions above:
Yes No
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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.

Thank you for taking the time to complete this profile.



 

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