Enhance your Beauty with Plastic Surgery. Bangkok offers the atmosphere for self rejuvenation.

Questionnaire

Please fill in the Medical Questionnaire for your Free Cosmetic Surgery consultation.

PERSONAL INFORMATION






YOUR DETAILS

Female Male  (required)

Day   Month   Year 

CHOICE OF PLASTIC SURGERY(s)




MEDICAL HISTORY

Yes No

Yes No
Yes No
Yes No
Low High OK
Yes No
Yes No
Yes No
Yes No
Yes No

Yes No

FOR WOMEN ONLY

Yes No


Yes No

Yes No

Yes No


Yes No

Note: Lactation may also be induced by other factors such as hormone intake. Please test by squeezing breasts

ADDITIONAL INFORMATION


UPLOAD PICTURES FOR FREE EVALUATION

Please make the pictures as clear as possible and take side view and front view pictures and back if relevant.

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Terms and conditions

Please read the following terms and conditions:

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