RE Plastic Surgery

...a subtle change on the outside for a significant change on the inside

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RE Plastic Surgery Contacts

Appointments & Scheduling:
0845 838 7928
Wound Care & Clinical Support:
07920 132 198
Mr. Yap:
lhyap@oneplasticsurgery.co.uk
Personal Assistant:
luisa@oneplasticsurgery.co.uk
Nurse Specialist:
phyllis@oneplasticsurgery.co.uk

Care Notes

Abdominoplasty
Blepharoplasty
Breast Augmentation
Breast Reduction
Facelift / Browlift
Rhinoplasty
Prominent Ears
Liposuction

Location

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Online Consultation Form

RE Plastic Surgery / Mr. L.H. Yap

Please help us by answering all questions as completely as you can:

1. What are your contact details?

Name:

Email:

Tel No:

2. What operation are you interested in having?

3. What is your current height, and weight (lbs.)?

Height (inches) (cm)

Weight (stones) (kg) (lbs)

4. As a courtesy to your General Practitioner (Primary Physician), we would like to inform them of any procedures you may be planning. Please indicate if you are happy for us to do so:

Yes No

5. If you answered 'Yes' to the above question, please provide your Primary Physician's contact details:

Physician Name:

Practice Name:

Practice Address:

Tel No:

Email Address:

6. Please indicate if you have any of the following medical conditions (Hold down the CTRL key to select more than one item on the list):

7. Do you have any other significant medical or psychiatric conditions?

Yes No If Yes, please elaborate:

8. Please select the body areas you would like to improve and rank them in numerical order (with 1 being the most important):

Breasts: 1 2 3 4 5 6 7 8

Abdomen: 1 2 3 4 5 6 7 8

Trunk: 1 2 3 4 5 6 7 8

Face: 1 2 3 4 5 6 7 8

Neck: 1 2 3 4 5 6 7 8

Eyes: 1 2 3 4 5 6 7 8

Ears: 1 2 3 4 5 6 7 8

Nose: 1 2 3 4 5 6 7 8

9. Have you had any prior cosmetic or plastic surgery?

Yes No If Yes, please elaborate:

10. If Yes, were you satisfied with the results of your prior surgery?

Yes No If Yes, please elaborate:

11. Please specify the location of any significant scars that you may have:

12. Are you considering surgery by Mr. Yap?

Yes No If Yes, please elaborate:

13. Do you have a preferred date for your procedure?

Yes No If Yes, please elaborate:

14. Do you have any further questions or concerns regarding surgery and procedures?

Yes No If Yes, please elaborate:

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