Article from Australian
Cosmetic Surgery Magazine

 

Agent : Beauty Borneo Connects Date : March 10, 2010
Guest's Name : Flight Arrival (Date) :
Date of Birth :
Flight Arrival (Time) : :
Age : Flight Arrival (Number) :
Gender : Flight Departure (Date) :
Height (in ft inches) : Flight Departure (Time) : :
Weight (in kg) : Flight Departure (Number) :
Mailing Address : Number of Nights :
Telephone :
Email :
Type of Surgery :
Hospital/ Surgeon : Sabah Medical Center,
Kota Kinabalu, Sabah
Consult Date :
Surgery Date :
Treatments :

  Please select the applicable answer. You are required to answer ALL questions (1-40) :
 
1. Asthma : 15. Hepatitis :
2. Bleeding disorders : 16. HIV Aids :
3. Blood clots : 17. Kidney problems :
4. Blood disorders : 18. Low Blood Count :
5. Blood preasure : 19. Pill :
6. Blood thinning medications : 20. Pregnant :
7. Breathing problems : 21. Previous surgery :
8. Depression : 22. Psychiatric illness :
9. Diabetes : 23. Reactions Anesthetic :
10. Drug dependence : 24. Scarring problems :
11. Epilepsy : 25. Sleep medications :
12. Eye problems : 26. Smoking :
13. General Health :
27. Thyroid problems :
14. Heart problems :        


28. Prescription drugs :
29. Have you visited Malaysia before?
30. Other medical conditions?
31. Other medications?
32. What is your reason for surgery?
33. Any food preference?
34. How important is your looks for you?
35. Are you realistic about your expectations?
36. Have you seen other surgeons for consultations?
37. Your concerns?
38. What are your own alternatives to surgery?
39. Any further questions you have?
40. What are your own stress levels?