Medical Questionnaire

PLEASE NOTE: It is necessary to provide us with all medication you use for all health problems in order to correctly indicate you to a surgery and allow you to have anaesthesia. In case if false, not complete information or concealed medical history is provided your treatment might be cancelled with no financial refund.

c of" "Portugal" "Paraguay" "Palestine, State of" "Qatar" "Romania" "Russian Federation" "Rwanda" "Saudi Arabia" "Sudan" "Senegal" "Singapore" "Solomon Islands" "Sierra Leone" "E

Images (at least one photo from the front and side):