Medical form - Ephesus Health Group

Medical History Form for Treatment Consultation

At Ephesus Health Group, your health and safety are our top priorities.
Before moving forward with any plastic or cosmetic surgery procedure, it’s essential to gather a complete picture of your medical history.
This allows our team to provide the best possible care and ensure a smooth surgical experience with optimal outcomes.

Why Is Your Medical History Important?

Understanding your medical background helps our surgical team take a personalized approach to your care.
This form enables us to:

Evaluate your overall health:
Ensuring that you are a good candidate for surgery.
Identify potential risks:
Detecting any conditions that could affect your recovery or the surgery itself.
Tailor a treatment plan:
Creating a procedure plan suited to your unique needs, ensuring both safety and aesthetic goals are met.

What to Expect from Your Consultation

Once you’ve completed the medical history form, one of our plastic surgeons will review it thoroughly before your consultation.
During your in-person visit, we will:

Discuss the results of your health assessment.
Address any potential risk factors identified in the form.
Clarify your expectations and goals for the surgery.
Provide a detailed explanation of the surgical procedure, including recovery time, potential complications, and expected outcomes.

Rest assured, your medical history will remain confidential and will only be used to enhance your care.
We are committed to providing you with the safest and most effective treatment possible.

Preparing for Your Procedure

After reviewing your form and completing a consultation, we may request additional information or tests to further assess your readiness for surgery.
This could include blood tests, imaging, or clearance from other medical specialists depending on your health history.
By providing complete and accurate details in the medical history form, you’re taking the first step towards a successful surgery and recovery.
We look forward to helping you achieve your aesthetic goals safely and with confidence.

Below, you will find our comprehensive medical history form.
Please take your time to fill out each section carefully and honestly.
This information will help us assess your suitability for surgery, anticipate any potential complications, and tailor a treatment plan that fits your individual health needs.

Full Name Date of Birth Gender Email Address Phone Number By what channel should we contact you? Which Procedure Are You Interested In? Your City & Country Which month do you prefer for your operation? Height (centimetres) Weight (kilograms) Please list any other surgeries you have had and when you had them Please list any medical conditions you have (Sleep apnoea, heart disease, hypertension, kidney disease, cancer, diabetes, hepatitis, seizures, depression, thyroid etc.) Do you use any medications regularly? YesNo List the Medications You Use Regularly Please list the medicines you are allergic to How many times have you been pregnant? Do you smoke regularly? YesNo If you smoke, how many cigarettes do you smoke per day? How often you drink alcohol ? Are you coming with a friend or alone? Where did you hear about us ? If you have a Referral Code, Please type bellow GDPR In order to continue your journey with Ephesus Health Group, we will need to process the personal information you have submitted and for this purpose, we will need to contact you via phone, email and SMS. You must accept to continue. By clicking Submit, you agree to our Terms and Conditions and that you have read our Privacy Policy.