PROMINENT EAR GALLERY - Dr Jain - Best Plastic Surgeon in India

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Which cosmetic surgery procedure you are interested in ? It is possible to combine different cosmetic surgery procedures in one sitting.

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Are you on any medication?

Allergies to any medicine?

Do you suffer from any ailments?

interested ailments? below.

Have you had any surgeries in the past ?

Were you admitted to hospital for any reason ?

Do you smoke? If so how many cigarettes / day.

Your height :

Weight (Current) & Maximum :

What was the lowest weight in the recent past ?

Does your weight fluctuate and if so by how much ?

Plz attach photograph of the area for which treatment is sought in the box provided below. (Front, side and where applicable, back view would be helpful.)

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