Cosmetic Surgery Quotes 

 

Tummy_Tuck_1.jpg

Surgeons Evaluation Form

No obligation and no cost evaluation. 

Fill in our form today and have one of our top Thailand surgeons review you for a personal and individual evaluation with a quote. 

Free Surgeons Evaluation

 Female
 Male

BOOKING DETAILS

EMERGENCY CONTACT

PERSONAL DETAILS

 Heart Disease
 Diabetes
 Hypertension
 Asthma
 Cancer

MEDICAL HISTORY

 Heart disease
 Diabetes
 Hypertension
 Deep Vein Thrombosis
 Cardiovascular
 Asthma
 Bleeding Tendancy
 Hyperthyroidism
 Adrenal Insufficiency
 Hepatitus
 HIV
 Keloid Scarring
 Cancer
 Major Operation
 Other
 Smoking
 Drinking
 Birth Control
 Hormone Replacement Medications
 Hormone patch or implant

BREAST SURGERY DETAILS

TIPS ON TAKING YOUR PHOTOS:

Breast Surgery: Please provide front, right and left side with arms at your side, and front, right and left side arms above head, and front leaning from the waist. All photos from neck to hips.

Body Photos: Please provide front, back, left and right side photos from neck to knees.

Face Photos: Please provide these without makeup, no glasses and hair pulled back. Please provide front, left and right side, front chin up, and front chin down. All photos from top of head to shoulders.

Photos: Please send photos to info@nip-tuckcosmeticsurgery.com

 I acknowledge that I have read and understood and accept the Terms & Conditions and cancellation policies/disclaimer of Nip-Tuck Cosmetic Surgery Ltd.
Please type the letters and numbers shown in the image.
 Captcha CodeClick the image to see another captcha.