Call Center: +66 8 4499 4470

Medical History

Specific Area
General Information

kg

cm

Habits
MEDICATIONS: Please list any medication you are taking with dose and frequency.
FAMILY HISTORY: Do you know of any blood relative who has or had
PAST MEDICAL HISTORY: Please check all that apply to you
PREVIOUS SURGERY:

Indicate the type of anesthesia received from the past, list any complications/reactions you experienced:
WOMEN PATIENTS ONLY:
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Naravee Aesthetic Clinic:16 Udom Suk Soi 30,
Sukhumvit 103 road, Bangna 10260 Thailand

Mobile: +668-4499-4470
Fax:+66-2398-8565 Ext. 425
E-mail: