Free 2nd Opinion Now!

A few basic details from you and we will have experts from a variety of specialist hospitals have a look at it.

* All fields are mandatory.

Patient Details

Patient’s Contact Details

Medical Conditions

Are you/have you ever had:
  • Any psychiatric conditions
    Irregular Heartbeat
  • Kidney Problems
    Liver Problems
  • Migraine Headaches
    Nervous Breakdowns
  • Nose/Throat Problems
  • Pneumonia
    Rheumatic Fever
  • Seizuress
    Shortness of Breath
  • Skin Cancer
    Stomach Problems
  • Stroke
    Thyroid Problems
  • Transfusion
  • Do you take birth control pills or any hormone replacement medication or patches?
  • Are you pregnant?
    (Pregnant women must take a pregnancy test before departure as most pregnancies can disrupt surgery)