ONLINE ASSESSMENT Name Email Phone number Country where you live? Estimated month of surgery? Estimated month of surgery?EneroFebreroMarzoAbrilMayoJunioJulioAgostoSeptiembreOctubreNoviembreDiciembre What surgery are you interested in? What surgery are you interested in? Mommy Makeover Abdominoplastia Mamo Aumento Ácido Hialurónico Lipoescultura Rinoplastia Otoplastia Mamoplastia Gluteoplastia Mamopexia Marcación Abdominal Botox Lifting Age How much do you weigh? How tall are you? (Height) Do you suffer from any illnesses? What surgeries have you had? (PLEASE SPECIFY YEARS) Are you allergic to something, to what? Do you take any medications or supplements, which ones? How many times have you been pregnant, in total? How many times have you been pregnant, in total?0123456 When was your last pregnancy? PLEASE SPECIFY NORMAL PART OR BY CESAREA Have you had any losses, how many? You plan, with what? You plan, with what?SINO What are you planning with? Do you use any recreational substances? Do you use any recreational substances?SINO What recreational substance do you consume? Smoke? Smoke?NOSI How much a week? How much a week?TODOS LOS DÍASCADA 8 DÍASCADA 15 DÍASUNA VEZ AL MES Drink? Drink?NOSI How often? How often?TODOS LOS DÍASCADA 8 DÍASCADA 15UNA VEZ AL MES 1 + 13 = SEND Send photos from the front, on both sides and back. No underwear (maximum editing the intimate areas, as long as it's not the area you want to operate. Click on: "Browse Files" To be able to upload the images
