HAIR TRANSPLANT MEDICAL FORM

Dossier médical Ang greffe cheveux

Personal informations

Medical information

Do you smoke?
Have you quit smoking?
Do you drink alcohol?

Medical background

Have you ever done hair implants?
Are you currently under medical treatment?
Are you allergic to any medications ?
Do you have other allergies?
Do you suffer from high blood pressure?
Do you suffer from diabetes?
Are you anaemic?
Do you suffer from cholesterol?
Have you ever had phlebitis?
Do you have a cardiovascular disease
Do you have a viral illness, cancer, AIDS or other serious diseases?

Surgical history

Have you ever had any surgery?
Have you had problems following anaesthesia
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