Medical Questionnaire form
The information contained in the document is strictly confidential. Should you require a procedure after three months of completing this form, you will have to complete a new questionnaire. These forms are only valid for three months only.
I hereby undertake that the information given in this questionnaire is correct and that I have read and understood and agreed to the Terms & Conditions
For assessing your suitability for the treatment by plastic surgeon or dentist please Email us the photos of the area to be treated; for dentistry we will need panoramatic x-ray.