Home Contact Us
About the Doctor  |  About the Center  |  About Plastic Surgery  |  Why Us  |  Finding the Right Surgeon  |  Procedures  |  Before & After  |  Cyprus  |  Financial  |  Patient Stories  |  Booking Info
Booking Info
Book Your Beauty
Book Your Travel
Book Your Accomodation
Post Operative Personal Responsibility
Privacy Policy
Terms & Conditions

 


Book Your Beauty
(E-mail)
Next of kin details, to be contacted in case of emergency only
Please answer the following questions fully.The information is treated as strictly confidential and is necessary to insure that the key health aspects are considered prior to your consultation in Cyprus. Plastic Surgery is a serious Surgical Procedure.
How would you say your skin heals?
If you smoke how many a day?
Do you have a smokers cough?
How is your general health?
What is your blood group?
Does your religion prohibit you from having a blood transfusion in the unlikley event that you may need one?
Are you being treated or have you been treated for any of the following?
If yes or no, past or present, please select appropriate boxes, give full details and list medications prescribed in the details section further down the form.
Do you have any allergies associated with foods medication
surgical tape elastoplast:
Have you had ANY surgical procedures before that required
you to have a general anesthetic? If yes, please supply full details:
Have you ever had any negative reactions to local or
general anesthetics? If yes, please supply full details:
Ever had a blood transfusion? If yes please give full details:
Breast Surgery
When was your last mammogram and what was the result?
Has any family member suffered from breast cancer?
If yes, please supply details:
Have you had any breast lumps cysts? If yes please supply details:
If it were found to be necessary would it be possible to
discuss your medical history with your GP As cosmetic surgery is an
elective procedure we would only contact him her directly
with your express permission:
(If yes please supply GP details below)
Telephone:
Choice of Surgical Procedure(s)
Preferred Accommodation Details:
Preferred Diet:
Have you read our terms and conditions?
Additional Comments?
 
©2010 Dr Harris Zavrides |  Disclaimer Design by BDigital | Maintained and hosted by RayboxStudio