Have you ever consulted a doctor for this/these procedure(s)? *

Do you smoke? *

Do you drink alcohol? *

Are you currently under medical treatment? *

Are you allergic to any medications ? *

Do you have other allergies? *

Do you suffer from high blood pressure? *

Do you suffer from diabetes? *

Are you anaemic? *

Do you suffer from cholesterol? *

Have you ever had phlebitis? *

Do you have a cardiovascular disease *

Do you suffer from depression? *

Do you have a viral illness, cancer, AIDS or other serious diseases? *

Have you had problems following anaesthesia *