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MEDICAL HEALTH ASSESSMENT

Medical Health Assessment

The purpose of this Medical Health Assessment form is for our medical team to best understand your state of health and provide best individualized treatment solution to you.


Current Complaints / Area for Improvement:

Please specify if you have any current health complaints or any areas would like to improve your state of health. 


COVID - 19 :


Gynecological History (for females) :


Urological History (for males):