BRAZILIAN BUTTOCK LIFT

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Please answer the medical questions below to complete your assessment;

1. Have you ever had surgery before? *

2. If yes, please provide further details *

3. If yes, when and what was the procedure? *

4. Do you have any children? *

5. If yes, how many and when were they born? *

6. Are you a smoker? If yes, how many per day? *

7. Are you currently breastfeeding ? *

8. Is there any chance that you could be pregnant? *

9. Are you currently on any form of birth control? If yes, please specify and indicate whether it contains oestrogen. *

10. Are there any health concerns that we should be aware of? If yes, please specify. (for example, thyroids, hepatitis, tuberculosis, high/low blood pressure) *

11. Do you have any allergies? If yes, please specify. *

12. Do you use or take illegal substances? If yes, please specify and indicate the last time you used. *

13. What is your current weight? *

14. What is your current height? *

15. How old are you? *

16. Do you have any upcoming surgeries or procedures [medical or not] that we should be made aware of? *

17. Are you currently taking any medication? *

18. If yes, what medication are you taking? *

19. What are the areas you are hoping to have liposuction? *

20. What shape are you hoping to achieve? *

NOTES *

Max File Size 50 Mb. *

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2. Max File Size 15 Mb.

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