Name Mobile number How old are you? Do you have any chronic illness? (Such as heart disease and diabetes) Do you use any medications regularly? (Such as insulin and anticoagulants) Are you a smoker? Are you addicted to any drug? Do you have any allergies? Have you had any surgery? (Including hair transplant) Do you have a needle phobia? Do you think your pain threshold is too low? Do you have a genetic heart condition in your family? Have you had local or general anaesthesia in the last 2 years? Do you have/ had any contagious disease? (Such as Hepatitis A/B/C and HIV) When would you like to have the operation? (optional) Which country's passport do you hold? Is it valid for at least 1 year? Do you have a Turkish visa? If not, do you require an e-visa or an embassy visa? Is there anything else you would like to add? (optional)
