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.

Step 1 of 5 About 6 minutes

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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

Which country are you writing from?

Please note: the length of stay required in Türkiye can differ depending on the country you travel from, so this detail is important for planning.

2Your Goals

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

When are you planning to have the surgery?

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 many cigarettes (or equivalent) do you smoke per day?

How often do you drink alcohol?

Never Occasionally (socially) Weekly Daily

7Body & Weight

Height (cm)

Current weight (kg)

Have you had obesity (bariatric) surgery?

Yes No

How many kilograms have you lost in total since the surgery?

Do you use, or have you recently used, weight-loss injections (e.g., Ozempic/Wegovy/semaglutide, Mounjaro/tirzepatide)?

Yes No

Which injection do you use or have you used, and when did you last take it?

How many kilograms have you lost in total with the injections?

Has your weight loss stopped?

Yes, my weight is stable No, I am still losing weight

For how many months has your weight stayed the same?

9Mental Health

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

Yes No

What is your diagnosis?

Have you used, or are you currently using, medication for it?

I am currently using medication I used it in the past, not now I have never used medication

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

Before submitting, you can read how your data is processed in the Privacy & KVKK notice. Privacy & KVKK notice

Additional comments or questions for your surgeon

Do you feel ready for this surgery?

Yes No Undecided

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

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