Op. Dr. Yasemin Aydınlı

Plastic Surgery — Pre-Operative Health Assessment

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Please answer the questions below honestly and completely. This information helps your surgeon plan a safe procedure. All answers are confidential.

1Personal Info

Tell us who you are and how to reach you.

Full name

Date of birth

Sex assigned at birth

Female Male Prefer to self-describe

Phone number

Email address

2Your Goals

Which procedure(s) are you considering, and what are your goals?

4Medications & Allergies

List all current medications and dosages, including any blood thinners or aspirin.

What vitamins, supplements, or herbal products do you take? (Write "none" if not applicable.)

Do you have any allergies (medications, latex, foods, or other)? If yes, please list them and the reaction.

5Lifestyle

Do you smoke or use tobacco or vaping products?

Never Former smoker Current smoker

How often do you drink alcohol?

Never Occasionally (socially) Weekly Daily

7Body & Weight

Height and current weight (e.g., 170 cm, 65 kg)

Have you had obesity (bariatric) surgery? If yes, how much weight have you lost, and has your weight loss stopped (plateaued)?

Do you use, or have you recently used, weight-loss injections (e.g., Ozempic/Wegovy/semaglutide, Mounjaro/tirzepatide)? If yes, which one and when did you last take it?

9Mental Health

Have you been diagnosed with anxiety, depression, or another mental health condition?

Yes No

10Photos

Please add clear photos of yourself in the standard positions shown below. Use a plain background, good even lighting, and no filters — underwear is fine. For face procedures follow the face poses; for body or breast procedures follow the body poses.

Body photo positions: front, back and side — Body — front, back & side

Face — front, ¾ & profile

📷 Add your photos

Up to 8 photos. Your photos are confidential and used only for your surgical assessment.

11Consent

Additional comments or questions for your surgeon

Your medical information is sent securely and only used for your surgical assessment.