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USA phone: 818-627-8732
Medical
Procedures
IVF In vitro fertilization
Weigth loss surgery
Cosmetic & Plastic surgery
Stem Cell
Orthopedics
CCSVI treatment
General surgery
Health & Wellness
Dental
Ophthalmology
Cardiac Surgery
Aftercare
Destinations
Medical Tourism
Costa Rica
Panamá
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Hospital Clínica Católica
Clínica Bíblica
Hospital Punta Pacífica
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Frequently
Asked Questions
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Any Question?
Information Form
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Medical Form
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Medical Form
Desired medical procedure
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Full Name
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Marital Status
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Occupation
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Children? Ages?
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Specify pregnancies, birth, abortions
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Address
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Postcode
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Your E-mail
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Telephone
Business telephone
Mobile
Date of Birth
Age
Gender
Current Weight
Current Height
BMI
Cholesterol level
Language Spoken
Have A Passport?
Proposed Date for arrival
Local Physician
Your doctor's telephone
What type of surgery or treatment are you interested in?
Reason you wish to have this surgery/treatment?
Previous Surgeries Undergone and date.
If yes, what procedure did you have?
If yes, Where you satisfied with results? Why?
How is your health in general?
Do you smoke? How often?
Do you drink alcohol? How often?None/ Daily/ Occasionally
Nervous System alterations or illness:
Sleep Apnea?
How often do you snore?
Do you feel sleepy during the day?
Migraine?
Any negative experience with anesthetics?If yes, please specify:
Allergies
Hormones
Blood Pressure High:
Blood Pressure Low:
Heart Disorders:
Diabetes:
Kidney Bladder disorder:Details.
Osteoporosis:Details.
Arthritis or joint pain?Details
Liver Conditions:
Reflux:
Heartburn:
Ulcers:
Asthma Etc:
Cataracts:
Back problems:
Lung Disorder:
Stomach Disorders:
ENT complaints:
H.I.V. /AIDS:
Cancer:
Hepatitis or liver disease:
Anemia or bleeding:
Clotting disorder:
Diabetes type I or type II:
Varicose Veins Etc:
Porphyria:
Epilepsy Etc:
Orthopedic Problems:
Dental procedures needed?Please specify.
Excess Bleeding:
Current Medication:
Tropical Diseases:
Any Recent Illness:
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Any comment or question!
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Contact Info
Please contact us via our contact form, or e-mail directly to the following numbers & emails.
Chief Executive Officer
ceo@premieremedicine.com
Customer Service
talktous@premieremedicine.com
Give us a call!
818-627-8732
Feature Procedures
IVF In vitro fertilization
Weigth loss surgery
Cosmetic & Plastic surgery
Stem Cell
Orthopedics
CCSVI treatment
General surgery
Health & Wellness
Dental
Ophthalmology
Cardiac Surgery
Aftercare