All your information will be used for medical history purposes only.
There is no obligation by filling out this Health Questionnaire. Terms and Conditions only apply upon booking your surgery if you decide to do so.
Today's Date *
Do you have a Skin problems?*
Do you have Rash problems ? *
Do you have Hives problems? *
History of High Blood Pressure? *
History of Heart Attack? *
History of Heart Disease? *
History of Embolism? *
History of Blood Clotting? *
History of Anemia? *
History of Bleeding Tendency/Disorder? *
To complete the process, we ask you to attach your photos of the areas you want to modify with plastic surgery and they should be sent as follows:
They should be taken without clothing or underwear and from the neck to the knees. Please do not include your face in photographs.
(Example of Image, Finals will be sent in separate file.)
These should be taken from head to shoulders.
Front side profile:
Left side profile:
Left angle profile:
Right side profile:
Right angle profile:
Important note: For a correct assessment by our doctor it is extremely important to follow the aforementioned indications.
Photographs are an essential requirement to continue with your evaluation process.*
I agree to the Terms and Conditions.
Winter season is a favorite for many reasons; the holidays, the Christmas break, cold weather outfits, comfy PJs, Starbucks hot beverages, and
At Bellphoria, our focus is your wellness This is why, in addition to our aesthetic medicine services, we offer treatments from a medical spa to