Yanhee Health Questions Application
You must apply first, before being accepted for a surgery date. Depending on your health status,
you may not be accepted to come to Yanhee Hospital for your procedure. Yanhee makes every
effort to ensure that you will have the highest possibility for the best results and a safe medical vacation.
Please fill out this application as thoroughly as possible. If you have any questions, please include them.
Then please email your answers to
Yanhee Health Questionnaire Application
Please fill out this application completely and as thoroughly as possible. If you have any questions, please email them to us along with the form. Please email your answers to us at USA@yanhee.net after you are done. After your application has been reviewed, you will be notified if you have been accepted.
If you are not accepted, we will explain to you why, and what you may need to do to pass all qualifications for surgery at Yanhee International Hospital. Thank you.
You can either copy and paste the list of questions into an email and then fill out the answers and email them to us or you can download the questions on to your computer and then attach them with your email.
You can also email us for an application if you have problems here with this page.
Application Downloads: PDF DOC WPS TEXT
1. First and Last Name. on passport
1. A - Please list your nickname/alias or future name that you would like to be called
1. B - If you are transgender or intersex patient, please tell us if you'd like to be addressed as Mr or Misses.
2. Date of Birth
3. Nationality
4. Passport number (if you do not have one yet, please skip)
5. Age?
Height?
Weight?
6.Gender (Male? Female? Ftm? Mtf?)
7. Gender on passport
8. Address (including street, city, state , zip code)
9. Best phone number to reach you directly
10. Best email to reach you directly
11. In case of emergency, who shall we contact? Please include full name, address, phone number, and relationship to you. Please give at least one contact.
12. Existing health conditions? Please list any existing health issues/diseases/conditions
13. Family medical history. Please list any family health history, such as diabetes, stroke, heart disease, cancer, etc.
14. Do you smoke/drink/use drugs? If so, please list what and how frequently
15. What kind of procedure/surgery are you interested in?
16. What date range are you wanting to have your surgery/procedure done?
17. Will you be coming with a friend or family relative? If so, what are their names?
18. What are your expectations for the results?
19. If you are seeking sex-reassignment-surgery, do you have a letter of recommendation from a doctor or other health professional?
19. Do you have any other questions for the doctor?
20. Do you have any feedback?
21. Are you aware of the risks and complications that may occur with any type of surgery?
22. Please give a rough estimate of the total amount of time you feel you've put into researching your particular surgeries/procedures.
23. Please detail the name of your current family physician or local doctor. We may need this information in the future, so that we can assist him or her in maintaining your health, after your surgery has been completed, and you have returned back home.
24. In 500 words or less, please tell us how having your surgery would change your life for the better and how this procedure will add to your happiness.
25. How did you first hear about Yanhee USA?
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