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Patient Enquiry Form for Plastic Surgeon

Patient Enquiry Form for Plastic Surgeon
Please give a brief description of the Procedure you are interested in:
Do you smoke or vape?
Do you have any history of poor healing, blood clots, or anaesthetic complications?
Have you had a surgical procedure with a general anaesthetic in the past 6 months?
Have you had any abdominal surgery in the past 6 months?
Have you had weight loss surgery in the past 12 months (if yes please name procedure)
Current implants (if applicable):
I confirm the information provided is accurate to the best of my knowledge.