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'Baby boomers' driving surge in male cosmetic surgery
09/12/2008

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Male members of the 'Baby Boomer' generation,... (read more)

Female Facelifts Reach Record Highs, Men Choose Nose Jobs
02/22/2008
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London, UK – 4 February 2008 – The British Association of Aesthetic Plastic Surgeons (... (read more)
Record numbers go abroad for health
11/01/2007

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Record numbers of Britons are flying abroad for medical treat... (read more)



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Confidential Medical Questionnaire for Patients

Section A. Personal Details
Name:
Address 1:
Address 2:
City/Town:
Postcode:Date of Birth:
Doctor's Name:
Address 1:Address 2:
City/Town:Postcode:
Section B. Medical Questions
Are you currently in good health?
- If you are currently under treatment by a Doctor please record the reasons below:
- If you are taking any medication or drugs (either prescribed or bought over-the–counter) or carry a drugs warning card please record below:
- If you suffer from any allergies please record below:

Do you suffer or have you ever suffered from any of the following conditions?
Rheumatic Fever
Any heart problems/heart murmer
High Blood Pressure
Chest Problems (asthma, bronchitis, TB etc.)
Diabetes
Epilepsy/ Fainting
Hepatitis/Jaundice
Have you been in hospital for operations or illness?
Do you have any problems stopping bleeding?
Are you pregnant?

Have you ever had any of the following?
A bad reaction to general or local anaesthetic?
A pacemaker fitted?
A blood-borne infection?
Steroids within the last two years?
C. Lifestyle Questions
Do you smoke tobacco products?
If yes, please select all that apply.  
 
 
 
Other (please state)
Do you drink alcohol?
If yes, how many units per week?
1 pint = 2 units, 1 measure of spirits = 1 unit, 1 glass of wine = 1 unit

Send Questionnaire

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