operation tuli intake

1
Your Name
First Name
Last Name
2
Address
Street Address
Street Address Line 2
City
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Postal / Zip Code
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Other
Country
3
Email* This field is required.
example@example.com
4
What is your relationship to the boy?
Please Select
Please Select
Self
Parent
Other family
Teacher
Friend or other
5
What is the boy's name?
First Name
Last Name
6
What is his date of birth? * This field is required.
Date
Year
Month
Day
7
What is his ancestry?If he has multi-ancestry check all that apply.
Filipino
Japanese
Chinese
White
Black
8
What is his religion?
Catholic
Protestant
Muslim
Other
9
Does the boy have any general health problems?
Clotting disorder
He take medications
He has allergies
Surgery or injury to his body, other than his penis or testicles
His general health is perfect
10
Conditon of penis and testiclesPlease check all that apply to confirm his state of health
Both his left and right testicles or normally formed and fully descended
Circumcision has been previous attempted
Foreskin is fully retractible
He has ever received blow to either his penis, left or right testicle (kick, punch, sports accident) hard enough to cause brusing or swelling
He has ever had an erection
He has ever ejaculated
11
What sport or physical activities does he partipate in?
12
Why does he wish to be circumcised?
13
How co-operative do you expect him to be? Most Filipino boys are very co-operative, but there are exceptions
Undressing and following general instructions.
Allowing his testicles to be checked. This could include applying pressure for up to one minute per testicle and could cause discomfort to his abdomen.
Holding still during the circumcision without need for restraint to sedation.
Friendliness
Row 0, Column 0Row 0, Column 1Row 0, Column 2Row 0, Column 3Row 0, Column 4
Row 1, Column 0Row 1, Column 1Row 1, Column 2Row 1, Column 3Row 1, Column 4
Row 2, Column 0Row 2, Column 1Row 2, Column 2Row 2, Column 3Row 2, Column 4
Row 3, Column 0Row 3, Column 1Row 3, Column 2Row 3, Column 3Row 3, Column 4
Undressing and following general instructions.
Allowing his testicles to be checked. This could include applying pressure for up to one minute per testicle and could cause discomfort to his abdomen.
Holding still during the circumcision without need for restraint to sedation.
Friendliness
Row 0, Column 0Row 0, Column 1Row 0, Column 2Row 0, Column 3Row 0, Column 4
Row 1, Column 0Row 1, Column 1Row 1, Column 2Row 1, Column 3Row 1, Column 4
Row 2, Column 0Row 2, Column 1Row 2, Column 2Row 2, Column 3Row 2, Column 4
Row 3, Column 0Row 3, Column 1Row 3, Column 2Row 3, Column 3Row 3, Column 4
14
How much skin does he wish removed? If you have caught him masturbing you should consider a tighter cut.
1
2
3
4
5
Minimal
Completely skinned
15
What outcome does he prefer?It may be possible to give him the dickhead shape he wishes
Pointed arrowhead
Flattened mushroom top
16
The following questions are for the boy to answer
Agree
Disagree
I want my dick to look like an American boys'
Row 0, Column 0
Row 0, Column 1
I have been teased for too much skin on my dick
Row 1, Column 0
Row 1, Column 1
If boys see my dickhead they will think I'm tough
Row 2, Column 0
Row 2, Column 1
I want a tighter cut even if it puts my balls at risk
Row 3, Column 0
Row 3, Column 1
I want a dick that will impress the girls
Row 4, Column 0
Row 4, Column 1
Circumcision will make me jakol less often
Row 5, Column 0
Row 5, Column 1
Removing too much skin will make it hurt to get a boner
Row 6, Column 0
Row 6, Column 1
Circumcision will make me togher, smarter and better at sports and concentrate more at school
Row 7, Column 0
Row 7, Column 1
I want my dick to look like an American boys'
I have been teased for too much skin on my dick
If boys see my dickhead they will think I'm tough
I want a tighter cut even if it puts my balls at risk
I want a dick that will impress the girls
Circumcision will make me jakol less often
Removing too much skin will make it hurt to get a boner
Circumcision will make me togher, smarter and better at sports and concentrate more at school
Agree
Row 0, Column 0
Disagree
Row 0, Column 1
Agree
Row 1, Column 0
Disagree
Row 1, Column 1
Agree
Row 2, Column 0
Disagree
Row 2, Column 1
Agree
Row 3, Column 0
Disagree
Row 3, Column 1
Agree
Row 4, Column 0
Disagree
Row 4, Column 1
Agree
Row 5, Column 0
Disagree
Row 5, Column 1
Agree
Row 6, Column 0
Disagree
Row 6, Column 1
Agree
Row 7, Column 0
Disagree
Row 7, Column 1
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17
Do you consent to the following being done by a trainee who may have little training or experience?Please recall this is a free service.
Testicle check
Circumcision
Should be Empty: