Loss of consciousness for any reason dizziness or headache
Eye problems (except glasses)
Asthma
Allergy
Diabetes
Heart problems
Blood pressure disorder
Stomach problems (ulcer, etc)
Uro-genital problems
Epilepsy or convulsions
Mental or nervous disorder
Problems with arms or legs incl.muscle cramp or joint stiffness
Blood disorder with tendency to bleeding
Blood group
Surgeries
Do you take any medicine or drugs regularly?
Have you had a tetanus shot? (Required) within the last 10 years
Have you had general anesthesia?
Have you had any complications during anesthesia?
Are you under a doctor's care?
Choose your model
Note : If your model is not on the list, please contact the administration
Important notice: Please indicate the person to whom the special reason must be addressed (legal representative for minors) and a telephone number with an international prefix (for example +995 000 00 00 00)
