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    ENGLISH-SPANISH

     

  • IMPORTANT!

    For an evaluation as accurate as possible it is necessary that you answer the following questionnaire, it only takes 5 minutes and you help us a lot. Please answer with the truth. If you lie or omit answers you can risk your health, your life or your outcome.
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  • Allergic to certain Medicine, Iodine, Latex, Tape?*
  • Do you smoke or recently quit smoking?*
  • Do you drink or recently quit drinking?*
  • Do you take any recreational drug?*
  • Do you know if any of your relatives suffered from any of these illness:*
  • Do you have previous SURGERIES? (aesthetic and non aesthetic)*
  • Have you done any NON surgical aesthetic PROCEDURES?*
  • If Done, Wich one?

  • Do you have any chronic ilness?

  • Do you take any medicine, herbal supplements or vitamins?
  • Have you been through any BARIATRIC surgery?
  • When
  • Which measure units do you use?*
  • How many POUNDS do you lost?*
  • How many KILOGRAMS do you lost?*
  • Have you any blood transfusion?*
  • Have you any Healing Problems?*
  • Any Coagulation problems?*
  • Any vein illness?*
  • Have you been pregnant?
  • In which kind of procedure you are interested in?*

  • In which Non surgical procedure you are interested in?
  • Which part of your body you want to improve? (You can choose more than one option)

  • Breast

  • What cup size you are?
  • What cup size you want to be?
  • Do You have a previous Breast Surgery?
  • Do You Have Implants?
  • Do you remember the volume of your implants?
  • Do you remember the Kind Of implant you have ?
  • Do you remember the surface Of implant you have ?
  • Do you remember the level Of placement of the implant?

  • Nose

  • Do you have breathing problems?
  • Any previous nose surgery?
  • Have you ever had any trauma or nose fracture?
  • Do You have any treatment for the trauma/Fracture?

  • Ears

  • Face, Neck, eyelids

  • Any previous Face, Neck or Eyelids surgery?

  • Abdomen

  • Any previous abdominal surgery? (Aesthetic and non aesthetic)

  • Body Contouring/Buttocks

  • Any previous surgery or Procedure?

  • Arms, Thighs, posterior upper back

  • Do you have Any previous surgery or Procedures these areas?

  • PRIVACY NOTICE

    Grupo Quirúrgico Estético de Baja California S de R L de CV is committed to protecting and respecting your privacy, and we will only use your personal information to manage your account, give you information about the products and services you requested from us. From time to time, we would like to contact you about your evolution, our products and services, as well as other content that may interest you.

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