Medical Questionnaire for Cosmetic or Plastic Surgery

You may download Medical Form in PDF
After completion please fax it to +36 1 266 0197

Please perform a comprehensive medical history.

All surgical procedures are accompanied by a certain degree of risk, whether the procedures are for medical or cosmetic reasons.  Dr Vincente Rodrigo careful review your medical history and current health condition before deciding if it is safe for you to proceed with surgery.  It is important that you fully disclose all pertinent information so that we are able to make an accurate assessment of the risks involved. Dr Vincente Rodrigo will take every precaution necessary to reduce the possibility of any complications. 

Before any type of major procedure, full medical tests are required which includes full blood test urine test and ECG. For tummy tuck and full face lift with anesthesia you need chest x-ray as well.

These tests can be performed:

Form Object

Contact Us

Name *
Email *
Phone *
Question
Verification:

Face Procedures

Body Procedures

Breast Procedures