SUBLIME Form

WELCOME DOLLS

Why Choose Us?

We have 20 Years Nursing Experience, trusted by hundreds of clients. Offering wide range of services from your Pre-Op to Post-Op Care to achieve your optimal results from your procedure.

Make sure your aftercare is with someone qualified

BOOK A CONSULTATION
PREMIER COMFORT CARE PACKAGE starts at $400
- Meet you at the surgery facility to help you with the discharge process
- Provide transfortation to your recovering location
- Pick up medications
- Room set up
- Up to 3 hours services
- Obtain prescribed medications
- Monitoring with Vital Signs & Symptoms of Infection Logs
PREMIUM COMFORT CARE PACKAGE starts at $750
- All services included with the Premier Comfort Care Package
- 5-6 hours of Private Nurse Care on the day of surgery
- 12 hours of overnight care provided by a CNA
- Complimentary transportation after surgery
- Extended monitoring with vital signs and symptoms of infection logs
ELITE COMFORT CARE PACKAGE starts at $1300
- All services included with the Premium Comfort Care Package
- 5-6 hours of Private Nurse Care on the day of surgery
- 12 hours of overnight care provided by a CNA for 2 days
- Complimentary transportation after surgery
- 2-4 hours of Private Nurse Care on the 2nd day after surgery
- Extended monitoring with vital signs and symptoms of infection logs
PRESTIGE COMFORT CARE PACKAGE starts at $1850
- All services included with the Elite Comfort Care Package
- 5-6 hours of Private Nurse Care on the day of surgery
- 12 hours of overnight care provided by a CNA for 2 days
- Complimentary transportation after surgery
- 2-4 hours of Private Nurse Care on the 2nd day after surgery
- Extended monitoring with vital signs and symptoms of infection logs
- Complimentary Stage 2 Faja
Premier Comfort Care Package Premium Comfort Care Package Elite Comfort Care Package Prestige Comfort Care Package
ADDITIONAL SERVICES

Choose any of the following services. To see full details about the services CLICK HERE
TRANSPORTATION SERVICES

Prescription Fill (Drop Off and Delivery) Surgery (Drop Off Only) Post Op Massages (Round Trip) Surgery (Pick Up Only)
TEXAS POST OP RECOVERY HOME CARE (HOUSES ONLY)

Pre Operative Appointment for Clearance Letter All Included 1 Session Post Op Drainage Massage (45 mins) Lymphatic Massage Maintenance (45 mins) 4 Session Post Op Massages 6 Post Op Massages 1 Session Advanced Seroma Drainage (45 mins) 1 Session Arms Only Drainage Massage (30 mins) 1 Session Emergency Drainage (After Hours only) 1 Session Fibrosis Treatment (45 mins) 1 Session Thighs Only Drainage Massage (45 mins) Stitch Removal Drains Removal
WELCOME MIA AESTHETIC DALLAS

PRE OPERATIVE CLEARANCE SERVICES starts at $300
- P re Op Surgery Labs $150
- Clearance Letter (History & Physical Included) $100
- EKG $75
10 POST OP MESSAGE SESSIONS + 1 STAGE 2 FAJA
- Stitches and Drains Removal
- Stage 2 Faja (FREE Arnica Teas or Wound Healing Teas
CHOOSE HERE

PRE OPERATIVE CLEARANCE SERVICES PACKAGE Pre Op Surgery Labs Clearance Letter EKG 10 POST OP MASSAGE SESSIONS
Name

First Name Last Name
Phone Number
Please enter a valid phone number.
Date of Birth

Month Day Year
Date
Email
example@example.com
Instagram Handle
Place of Lodging, please ensure parking is free and available

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Room or Unit Number
Arrival Date *

Month Day Year
Date
Surgery Date (Date challenges allowed 1x time additional date change applies $25 reschedule fee) *

Month Day Year
Date
Departure Date *

Month Day Year
Date
Procedure Type *
Specify Other
Doctor Name *
Facility Name *
Any previous procedures or medical history *
Any Allergies *
Emergency Contact *
Additional Info, Additional Transport, Additional or Special Request

SERVICES

Premier Comfort Care Package

$ 400.00

Premium Comfort Care Package

$ 750.00

Elite Comfort Care Package

$ 1,300.00

Prestige Comfort Care Package

$ 1,850.00

Total

$ 0.00

Payment Methods

Credit Card

Cash App Pay

PAYMENT PLANS AVAILABLE

PATIENTFI Application Link CLICK HERE to apply

PAY with CHERRY CLICK HERE to apply

CARE CREDIT Application Link CLICK HERE to apply
We will send you a separate invoice for the additional services you added.

Any doctor's office more than 12 miles away is subject to mileage fee that will be added to your invoice

A welcome call will take place 1 week prior to your appointment to finalize your details ansd any changes or additions can be made.

Once information is confirmed, you have arrived in Texas and surgery is cleared. Services are NON-REFUNDABLE.
I authorize and have read and understood all terms of this form. I agree that all information entered by me is true. *

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