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HOME
TRAVEL TO IRAN
Iran Tours
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Accommodation
Accompaniment
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Iran Highlights
About Iran
MEDICAL TOURISM
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Cosmetic surgery
Cardiac Surgery
Kidney Surgery
Eye surgery
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Hospital Services
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VIP and CIP
Accommodation
Medical Consultation
INFORMATIONS
Medical Articles
FAQ
ABOUT US
CONTACT US
HOME
TRAVEL TO IRAN
Iran Tours
Culture Tours
Adventure
Experience & Extention
Services
Make Tour
Accommodation
Accompaniment
Transportation
Visa
VIP and CIP
Iran Highlights
About Iran
MEDICAL TOURISM
Health Tour
Cosmetic surgery
Cardiac Surgery
Kidney Surgery
Eye surgery
Ask For Quote
Services
Hospital Services
Hotels & Suites
Visa
Accompaniment
Transportation
VIP and CIP
Accommodation
Medical Consultation
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Medical Consultation Form
Name
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Last
Gender
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Age
Phone
Have you seen a doctor for any of the following illnesses?
High blood pressure
Yes
No
Heart disease
Yes
No
High Cholesterol
Yes
No
Diabetes
Yes
No
Bleeding disorder
Yes
No
Other Allergies (if any)
Penicillin
Sulfa Drugs
Codeine
Aspirin
Local Anesthetics
Other antibiotics
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Have you ever undergone surgery?
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No
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