Pectus Services, LLC - Our Services

Updated 1/26/10

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First Name:
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Age:		Male Female	Height: Weight:
Form of Pectus: Check all that apply.	Excavatum (Sunken Chest) Pectus Carinatum (Protruding Chest) Flared Ribs Tortum (combination PE & PC)
Age pectus first noticed:	Birth Years Old
Current Status of Pectus:	Stayed the Same Getting Worse
Haller Index (if known):
Location of defect on chest:	Left Center Right Upper Chest Middle Chest (nipple line) Lower Chest
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