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The clinic
Dr. Nicolas Zwillinger
The specialized team
About lipedema
Treatment of lipedema
Diagnosis of lipedema
Liposuction WAL
Before / After
Contact us
Rates
Pre-consultation form
Partner doctors
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The clinic
Dr. Nicolas Zwillinger
The specialized team
About lipedema
Treatment of lipedema
Diagnosis of lipedema
Liposuction WAL
Before / After
Contact us
Rates
Pre-consultation form
Partner doctors
Partner clinics
To read
Frequently asked questions
Testimonials
Inquire
Interviews
Videos
Français
Search
Close
Pre-consultation form
Our online form will help us establish a personalized diagnosis of your lipedema.
Name
First name
E-mail
Phone number
Date of birth
City
Job
Weight (kg)
Size (in cm)
Medication treatment(s)? If yes, please specify
Previous operation(s)? If yes, please specify
History of your weight (changes)
number of children
Disease(s)
Drug treatment? If yes, please specify
Operations carried out
Smoking? if so for how long and how many cigarettes/day
Areas affected by lipedema
Lower limbs
Upper limbs
Liposuction of affected areas?
Yes
No
If so, when and by which surgeon?
History of your lipoedema (for how long, evolution...)
Is there a history of lipedema in your family?
Do you engage in regular physical activity? If yes, which sport and how much time per week
Do you have a balanced diet?
Yes
No
Do you use lymphatic drainage?
For how long?
Has it been effective?
Have you worn compression stockings or tights?
Yes
No
Is the affected area painful?
On which areas are the pains present?
Hypersensitivity of affected areas?
Does it itch?
Do you have feelings of heaviness?
Do you have spontaneous bruising on the affected areas?
Is there any swelling?
Is walking limited?
Quality of life due to lipedema?
Aesthetic note of the areas affected by lipedema?
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