Thailand Gastric sleeve by DOODEE CENTER
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Email *
Full Name (As Per Passport) *
Birth Date
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Gender *
Whatsapp Number  
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Body Weight (In Kg's) *
Height (In CM)
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Nationality
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Preferred Language *
What Procedures Do You Require? You may select more than one. *
What Results Do You Want To Achieve? *
Have you previously had cosmetic surgery? *
Do You Have Any Questions For The Surgeon? *
Diabetes or blood sugar problems? *
Please clarify diabetes / blood sugar problems *
Thyroid problems?
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Heart problems?
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Lung problems?
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Blood pressure problems?
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Kidney or liver problems?
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Blood disorders?
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Previous/current history of cancer
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HIV or AIDS?
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Nervous breakdowns/Depression?
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Neurological problems?
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Anaesthesia problems?
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Do you suffer from Sleep Apnea? (Breathing stops for a period of time during sleep)
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Have you ever had a Stroke or Transient Ischaemic Attack (TIA)?
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Have you have had any medical conditions not mentioned above
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Are You Female And Requiring Breast Surgery and/or Tummy Tuck Surgery?
Have you been hospitalized, had surgery or received medical care within the past 5 years (including cosmetic surgery)?
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Do you have implants or metal objects in your body?
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If you answered "Yes" to the above, please specify.
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Do you have difficulty with healing or scarring?
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Do you have any allergies to food, drugs etc?
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List all medications you currently take and dosage you take for each.
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List all vitamins or food/nutritional supplements you currently take and dosage.
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Have you ever taken a MAO inhibitor such as Nardil, Marplan or Parnate?
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Have you ever taken Daily Coumadin, Daily Heparin or Daily Aspirin?
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Do You Smoke?
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Do You Drink Alcohol?
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