By SUBMITTING THIS FORM, you agree to the following:1) I give my permission to share photos with Silhouette Escapes in order to obtain a quote. 2) I understand I may be denied surgery during in person consultation if my health status is not deemed appropriate for surgery 3) I understand that although I may have lab work done through my primary doctor I will still be required to undergo and pay for all tests required by my surgeon 4) I understand that during in person consultation (both surgical and dental) other services may be deemed necessary to fulfill treatment and will be at my discretion 5)  I understand the importance of informing my consultant of all medical conditions and medications I am taking, and to let the consultant know about any changes to these. 6) I understand that deposits are non-refundable and may be used for up to 6 months 7) I understand my deposit is non transferable 8) Photos of your treatments may be taken to aid in record keeping, and to be used with your permission on social media to help advertise the services available. 9) I understand that any services cancelled during my trip may not be reimbursed 10) I certify I have been honest and forthcoming with my health history