|Are you 18 or older ?
|Date of birth
|Parent's Date of birth
|Parent's ID number
|Any heart condition:
|Allergies to: anesthetics, adhesive plaster, jewellery or latex?
|Are you pregnant or breastfeeding?
|Are you taking any blood or medication as Warfarin, Aspirin etc?
|Please list any current medications/treatments from the hospital
|How did you hear about us?
|How did you hear about us? :: other
|send aftercare email