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Dr Islam Abdelkhalek
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Dr Islam Abdelkhalek
Home
Your Trusted Surgeon
International Rewards
About
Certifications and Awards
Best Team Ever
Services
Medical Tourism
Patients Gallery
Testimonials
Live Testimonials
Success Stories
Our Partners
F.A.Q
Health Form
Contact Us
Health Form
Here you can assess your eligibility for the surgery. Please fill out the questionnaire and send it and you will have your status for approval after checking within 48 hours.
Full Name
*
Phone number
*
Country
*
Nationality
E-mail
*
Age
*
Weight
*
Height
*
Requested surgery
*
Required date
Are you on any medications? If yes please specify
*
Do you have heartburn reflux? If yes How often?
*
Have you had any previous surgeries?
*
Have you ever had bariatric surgeries?
*
Do you have history of medical illness?
*
Do you have history of blood clots?
*
Describe your eating habits (snacks, sugars, etc)
*
If you kindly attach a front and side view photo
File Upload
File Upload
Send
+20-1063270895
-
Support team
islam.abdelkhalek.surgery@gmail.com