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Neck Mass

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Neck Mass

Please fill in the form completely.

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Patient Information

Full Name *

Age *

Gender *

What is your complaint?

What are your complaints?

I do not have any

Lump in the neck

Pulsatile tinnitus (hearing thumping in ears)

Feeling pressure on your throat

Hoarseness

Other Complaints

Disease History

When did your symptoms start?

Please inform us about the history of your illness:

Please indicate your previous neck area radiotherapy treatments if you received any.

Your additional diseases:

Previous surgeries (if any):

Please indicate how long have you had your habits, and the amount of consumption.

Please state the medications you take on a regular basis (with doses)

Have you had any previous treatment for this disease?

Did you receive any treatments for this disease before?

I had an operation.

Radioactive iodine treatment (Nuclear medicine treatment)

Radiotherapy

Chemoradiotherapy (Receiving chemotherapy and radiotherapy at the same time).

E.g. neck mass excision, thryoidectomy, neck dissection (removal of lymph nodes from the neck)

Other Examinations

Reports and biopsy reports of the previous surgeries if you have had any.

Treatment plan of your previous radioactive iodine treatment, if received any.

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Pathology Reports

Biopsy report

Imaging (Radiology) Reports

Ultrasound of neck

Contrast computed tomography of neck

Contrast magnetic resonance imaging of neck

MR angiography of neck

Sestasimibi parathyroid scintigraphy

Laboratory Examinations

Hemogram (Complete Blood Count) Report

Biochemistry Report

I have read and understood the Information and Consent Text regarding the Provision of Remote Healthcare Services and hereby accept its terms.*

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