6/9/25, 4:22 PM
Assinatura
Documento de revisão
Illusions Plastic Surgery
2005 Palm Beach Lakes Blvd West Palm Beach FL
33409
(561) 331-3191
sales@illusionsplasticsurgery.com
MEDICAL QUESTIONNAIRE
You are required to complete the Medical Questionnaire provided diligently and
honestly. It is crucial that you allocate sufficient time to answer each question
thoroughly. The completion of this form is a prerequisite for initiating your preoperative
lab work process. Please be aware that the medical questionnaire must be filled out in its
Assinatura
entirety before any laboratory tests can be conducted. Kindly ensure that you provide
comprehensive medical and lifestyle information, as every detail is essential to give you
precise instructions. Based on the details you furnish in the questionnaire; the surgeon
may recommend additional tests or assessments. Not completing the questionnaire could
lead to a potential delay or cancellation of your desired surgery date.
Failing to meet the necessary requirements may jeopardize the progress of your surgery,
potentially leading to the need for rescheduling or even cancellation. It is essential to
ensure that all prerequisites, including BMI, are met to minimize any potential risks or
disruptions to your surgical procedure. Your doctor will weigh and measure you either on
your pre-op day or on the day of your surgery.
First Name: _____________________
Assine acima
Claro
Middle Name: _____________________
Desfazer
Ver documento Salvar e continuar
Last Name: _____________________
Continue a assinar
https://myillusions.nexuite.net/docusign/signature?doc=26340
1/1