Medical Questionnaire


Information enclosed in Medical Questionnaire and your photos are essential in order to enable our surgeons to see your problem and make a proper assessment. They will analyse the treatment you require and make a suggestion of what would be the best way to reach the best result for you.

Do not hesitate and fill in our Medical Questionnaire and submit it along with your photos of a particular area you wish to have treated. The best aspects for the photos are from the front and side. Once we receive them we will be able to provide you with the medical assessment within 24 - 48 hours. At the same time we´ll give you the exact price of your treatment including accommodation. We can assure you that our prices are accurate and hide no extra charges.

Are you interested only in an approximate price of your treatment and do you not intent to send us your photos? Get the estimated but maximal quote today by simply filling out of our Contact formular.

CONTACT DETAILS

Required fields are marked with an asterisk (*).

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PERSONAL INFORMATION

 
 
 

CHOICE OF SURGICAL PROCEDURE(S)

 
 
 

MEDICAL HISTORY

 
 
 

ADDITIONAL INFORMATION

 
 
 
 
 
 

ATTACH PHOTOS OF THE AREAS YOU WISH TO HAVE TREATED

 
 
 

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