Do you suffer or suffered from any of these diseases or health conditions? Check all that apply.
Do you take any medications or supplements regularly (for blood pressure, antidepressants, proteins, weight loss supplements, vitamins)?
Do you have children?
Do you take contraceptives?
Are you allergic to any medications?
Do you smoke?
Do you drink alcohol?
Previous Surgery
Have you had any previous surgery? Select what applies.
Send us pictures of you (front, side and rear)
On what date would you like to perform your procedure?
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