Medical History
Please answer honestly — this keeps any future treatment safe.
Do you have any chronic or past medical conditions?*
✓ None of these✓ Asthma / respiratory✓ Diabetes✓ High blood pressure✓ Thyroid disorder✓ Bleeding / clotting disorder✓ Heart disease✓ Kidney / liver disease✓ Genetic condition✓ Other (specify below)
Select at least one (choose "None" if not applicable)
Please give details about the condition(s) you selected* Required — please describe the condition(s) you selected
Have you ever been diagnosed with or exposed to any of these?*
✓ None✓ Hepatitis B✓ Hepatitis C✓ HIV / AIDS
Select at least one (choose "None" if not applicable)
Please give details about the diagnosis you selected* Required — please describe the diagnosis you selected
Hormones, blood thinners & related medications — are you currently taking any of these?*
✓ None of these✓ Hormone Replacement Therapy (HRT)✓ Oestrogen / Progesterone✓ Testosterone✓ Contraceptive pill / hormonal IUD / implant✓ Blood thinners (Warfarin, Heparin, Xarelto, Eliquis)✓ Antiplatelets (Aspirin, Plavix, Clopidogrel)✓ NSAIDs regularly (Ibuprofen, Naproxen)✓ Corticosteroids / steroids (Prednisone)✓ Weight-loss medication (GLP-1, Ozempic, Saxenda)✓ Herbal supplements / vitamins (Fish Oil, Vit E, Garlic, Ginkgo)
Please select — choose "None of these" if not applicable
Current medications, supplements & hormonal therapies*
Required — write "None" if not applicable
Allergies (medication, latex, anaesthesia, food)*
Required — write "None" if not applicable
Quick yes / no
Do you regularly use herbal teas or remedies? No Yes
Are you pregnant or breastfeeding? No Yes N/A
History of miscarriage or stillbirth? No Yes N/A
Any history of cancer in you or your family? No Yes
Have you had any previous surgeries? (incl. minor / older) No Yes
Please give details* Required
Any complication with anaesthesia in the past? No Yes
Any non-surgical aesthetic procedures? (Botox, fillers, laser, HIFU, threads…) No Yes
Please specify & approximate dates* Required
Do you smoke or vape? No Yes
Willing to quit before & after surgery?*
Yes No Not sure
Please select
Do you consume alcohol? No Yes
Treatments & Photos
What you are interested in, your goals, clear photos and any reports.
Treatment(s) you are interested in*
✓ Facelift / Facial Rejuvenation✓ Rhinoplasty✓ Eyelid (Blepharoplasty)✓ Jaw / Orthognathic Surgery✓ Facial Implants✓ Body (Lipo / Tummy Tuck / BBL)✓ Breast (Aug / Lift / Reduction)✓ Hair Transplant✓ Dental / Smile Design✓ Weight Loss Surgery (Bariatric)✓ Urology & Men's Health✓ Gynaecology / IVF✓ Reconstructive Surgery✓ Medical Aesthetics (Botox / Filler / Skin)✓ Other / Not sure yet
Select at least one
What are your goals / expectations?* Please share your goals
Tell us your story Optional, but it really helps us understand you.
When are you planning to come?
Select… Within 1 month 1–3 months 3–6 months 6–12 months Just researching
How did you hear about us?
Select… Instagram Facebook TikTok YouTube Google search AI assistant (ChatGPT, etc.) Referral / friend Another patient Other
Your photos 0 / 5
Upload at least 5 clear photos following the guide above*
Please upload at least 5 photos
Reports, CT scans & documents 0
Optional — anything that helps our doctors
Blood tests, previous operation reports, CT / MRI scans (a ZIP of DICOM files is fine), panoramic dental X-rays — whatever you already have.
Health & Medical Travel