Free Surgeons Evaluation

 Female
 Male

TRAVEL COMPANIONS DETAILS

BOOKING DETAILS

EMERGENCY CONTACT

PERSONAL DETAILS

FAMILY MEDICAL CONDITIONS
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 No
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 No
 Yes
 No
 Yes
 No
 Yes
 No

MEDICAL HISTORY

Do any of these apply to you?
 Yes
 No
 Yes
 No
 Yes
 No
 Yes
 No
 Yes
 No
 Yes
 No
 Yes
 No
 Yes
 No
 Yes
 No
 Yes
 No
 Yes
 No
 Yes
 No
 Yes
 No
 Yes
 No
 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, and front, right and left side diving position photos

Body Photos: Please provide front, back, left and right side photos

Face Photos: Please provide these without makeup, or glasses and hair pulled back. Please provide front, left and right side, front chin up, left and right side chin up.

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.
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All surgical procedures have risks and benefits.  We suggest that you make yourself aware of the risks and benefits and if you are unsure and have concerns discuss this with your doctor.  A face to face surgeons review of each individual person's procedure is required for a final assessment before proceeding with surgery.  A website review of your case will not replace this but will provide an estimate of cost and advice for you individually from a qualified surgeon. We also suggest suitable travel insurance is obtained before travelling overseas.   Medical travel insurance can be obtained from some international insurance companies outside of NZ.  We have a list of these if you would want more details.

For more information on our Terms & Conditions, Cancellation Policies and Disclaimer please email us at info@nip-tuckcosmeticsurgery.com.