Online Consultation Medical History - Dr. Jorge Ivan Cañas
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High-level Facial Surgery in Medellín, Colombi.a

Medical consultation Form

Please complete the following medical history form with as much sincerity and detail as possible. This is essential for Dr. Jorge Iván Cañas’ diagnosis and his surgical proposal.

1. Medical History

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Name and Last Name
Gender
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Numeros y letras del documento

Contact Info

Address

Medical Information

Have you had previous surgeries?
Have you suffered from any illness?
Do you have any allergy?
Have you had previous blood transfussions?
Do you currently take any medications?
Have you ever been hospitalized?
Do you have a history of family illnesses?
Are you currently healthy?

Life Style

Do you do physical activity/sports?
Do you use recreational drugs and/or narcotics?
Do you use tobacco, vapes or electronic cigarettes?
Do you consume alcohol?
Are you interested in a Lipoescultura or Abdominoplasty in this consultation?

Psycho-emotional profile

Answer the following questions with complete sincerity
0 = A lot of anxiety and/or worry , 10 = Very happy and happy

Purpose of the consultation

Clearly describe what goals you want to achieve in your body. Do it in order of importance from highest to lowest. Place all the details you can imagine; This brings us closer to a higher degree of satisfaction.
Political acceptance
Contact acceptance

Cita virtual con el Dr. Jorge Iván Cañas

A TOP experience is waiting for you with Latin Facial Plastic Surgery in Medellín.

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Scarless Facial Rejuvenation

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Deep Plane Facelift

Most efective facial rejuvenation technique

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