Medical History

Important! Please Read!

In order to make an accurate assessment and help you as much as possible before the actual procedure, please be so kind and take note of the information below and/or answer the following questions for me. The sections have been chosen based on the procedures you have selected on my website.

If you have asked for the cost of a particular procedure, please note that once I have received the required photographs, I can give you an accurate quote, which isn’t possible without first having seen them.

    Why are you considering this procedure?

    Give details of the procedure you are requesting:

    Allergies:

    Have you consulted a surgeon for this procedure?

    Do you drink or smoke?

    Have you ever had a General Anesthetic?Are you prone to KELOIDS or poor scaring?Have you ever been ANEMIC?Do you have ASTHMA or LUNG DISEASE?Do you have HIGH BLOOD PRESSURE?Do you have any known HEART problems?Have you ever been JAUNDICED?Do you or any relatives have DIABETES?

    If you are from out of town when would you consider traveling to South Africa? Select Date:

    General Health:

    1. Have you ever been treated for psychiatric illness? This includes depression.

    2. Do you suffer from diabetes or high blood pressure?

    3. Would it be possible to get a comprehensive report from your physician/psychiatrist in terms of your condition? (Check the box, If Answer Is Yes)Yes

    4. Have you suffered from previous deep vein thrombosis, i.e. blood clots, developing in the leg following long air flights, long hospital stays, etc?

    5. Have you ever taken or abused drugs, i.e. cocaine, herion, marijuana?

    6. Have you consulted any plastic surgeon with respect to proposed surgery?

    Photographic Instructions:

    All this information helps immensely in terms of making my final assessment. It is important that the above are answered completely and any details which you think may be significant should be submitted to me.

    Photographs should preferably be taken digitally and e-mailed to ashleigh@alchimiaclinic.co.za. This will be much quicker than posting normal photographic prints, but please reduce them to a manageable size (about 500-600 pixels wide and in JPG format) rather than sending them in their original rather large size. Please put your name in the subject line.

    In order for Dr. Jedeikin to make a thorough assessment, he requires good quality photographs to be emailed to him. Please read the following photographic requirements carefully. Full description of how to take the photographs will be explained to you.
    Photographs should preferably be taken digitally and e-mailed to ashleigh@alchimiaclinic.co.za. This will be much quicker than posting normal photographic prints, but please reduce them to a manageable size (about 500-600 pixels wide and in JPG format) rather than sending them in their original rather large size. Please put your name in the subject line.

    Please read the following photographic requirements carefully
    https://www.plasticsurgerysa.co.za/wp-site/download.pdf

    Our Procedures