Consultation Form

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1-Have you done * blood test* recently ? Hipatit B/C or HIV? If so when was it ? what was the results?

2-Have you gone through any previous surgical or cosmetic operations?

3-Do you take any medication?

4-Do you suffer from any permanent diseases (diabetes, blood pressure, cholesterol, etc.)?

5-Do you have any allergies?

6-Do you smoke or drink?

7-Have you determined the date of your arrival to Istanbul? If so when is it?

Since when you're suffering from hair loss?

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Date of Birth: *

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