Request a Teleconsultation

  • Teleconsultation Request

  • Welcome to Gorgeous Getaways !

    Your Destination Manager will confirm available dates/times for your teleconsultation.

    Keep in mind that your medical history and photos are a requisite to be a candidate for teleconsultation.

     

  • Have you completed a medical form prior?
  • Requested Teleconsultation Date
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  • Patient Information

    Please complete the information below
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  • Surgery Details

    Please tell us the procedures you are interested in
  • Is this for gender transition surgery?*
  • Can you provide a referral letter from your psychologist, sex therapist or psychiatrist
  • Browse Files
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  • When are you planning to have your surgery done ? 

  • Arrival Date
     - -
  • Requested Date of surgery*
     - -

  • Medical

    Please complete both the family and patient medical sections

  • Your Family Medical

    Please indicate if you have a history of these conditions in your family. 

  • Heart Disease*
  • Diabetes*
  • Hypertension*
  • Asthma*
  • Cancer*

  • Your Personal Medical

    Please indicate if you have any of these conditions.

  • Heart Disease*
  • Diabetes*
  • Hypertension*
  • Deep Vein Thrombosis*
  • Cardiovascular Accidents*
  • Asthma*
  • Bleeding Tendency*
  • Hyperthyroidism*
  • Adrenal Insufficiency*
  • Hepatitis*
  • HIV*
  • Keloid Scarring*
  • Cancer*
  • Underlying Disease*
  • Drug or Food Allergies*
  • Current Vitamins, food nutritional supplements*
  • Are you on current medications and dosage?*
  • Ever been treatmented for depression?*
  • Vaccination Status*

  • Habits

    Please describe your current personal habits
  • Drinking?*
  • Smoking?*

  • Women

    This section is for women only
  • Pregnant Now?
  • Birth control pills, hormone replacement medications, hormone patch or implant?
  • Planning for more pregnancies?

  • Breast Surgery Clients

    (Please complete if having breast surgery)

  • Photos or Files

    Please upload your photos securely.

  • Please upload your photos as per the instructions below.  These will be sent to the surgeon for feedback and confirmed price.  Once your firmquote is ready, the teleconsultation will be scheduled.

    The following are guidelines for submitting photos your photos:

    1) Breast Augmentation and Breast Lift photos must be taken without undergarments from the neck to the waist with both arms down by the sides, as if standing to attention:

    Left Profile
    Right Profile
    Front On
    Back on

    2) Facelift, Necklift and Rhinoplasty photos must show head and neck:

    Left Profile
    Right Profile
    Front On
    Head Tilted Backwards
    Head Tilted Downwards 

    3) Mommy Makeover, Tummy Tuck, Liposuction and Brazilian Butt Lift photos must be taken without undergarments from the neck to the feet, with both arms down by the sides, as if standing to attention:

    Left Profile
    Right Profile
    Front On
    Back On 

    4) Thigh Lift Photos must include:

    Left Profile – Showing Inside Thigh
    Right Profile  – Showing Inside Thigh
    Left Profile – Showing Outside Thigh
    Right Profile  – Showing Outside Thigh
    Front On
    Back On 

    5) Arm Lift Photos must include front photos:
    Left Arm - Raised At Side Of Body
    Right Arm - Raised At Side Of Body

     

  • Upload Files
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  • Thank You for Completing!

  • More More Information please visit www.gorgeousgetaways.com

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