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Transplant flokësh me safir FUE
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Kontaktoni
Shtëpi
Hair Transplant
Transplanti i flokëve FUE
Transplant flokësh me safir FUE
Transplanti i DHI
Transplanti i mjekrës
Transplanti i vetullave
Transplant flokësh për femra
Para dhe Pas transplantit të flokëve
Rreth Nesh
Kontaktoni
Blog
FAQ
Shtëpi
Hair Transplant
Transplanti i flokëve FUE
Transplant flokësh me safir FUE
Transplanti i DHI
Transplanti i mjekrës
Transplanti i vetullave
Transplant flokësh për femra
Para dhe Pas transplantit të flokëve
Rreth Nesh
Kontaktoni
Blog
FAQ
Historia Mjekësore
Shtëpi
Historia Mjekësore
Medical History
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Date
*
Name
*
First
Last
Treatment Type
Age
*
Height
*
Weight
*
List of medications you are currently using (including over-the-counter medications)
*
List of surgeries you have performed before (including plastic surgeries)
*
Date of Intervention
*
Surgical Intervention
*
Use herbal supplements or vitamins (especially Gingko, ginger, garlic, St. John’s Wort, C, E, fish oil)?
*
Medicines that cause allergies
*
Are you a smoker?
*
Yes
No
If yes; For how long?
Are you an alcohol user?
*
Yes
No
If yes; For how long?
Do you have any of the following symptoms?
Chest pain
*
Yes
No
Breast diseases
*
Yes
No
Seizure
*
Yes
No
Heart problems
*
Yes
No
Thyroid problems
*
Yes
No
Tooth problems
*
Yes
No
High blood pressure
*
Yes
No
Hepatitis C
*
Yes
No
Emotional problems
*
Yes
No
Diabetes
*
Yes
No
Kidney problems
*
Yes
No
HIV
*
Yes
No
Cancer
*
Yes
No
Asthma
*
Yes
No
Eye problems
*
Yes
No
Problems with bleeding
*
Yes
No
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