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A bit more about you

Sorry for the personal questions, these help us treat you

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Primary contact & how best to reach you

Please help us to keep you informed every step of the way.

Please enter the name and phone number of the person who will accompany you on the day of your procedure. Note that for safety reasons, you will not be permitted to drive or to leave unaccompanied after your surgery.

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Medical & Surgical History

This will help us know how best to treat you

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