Gorgeous Getaways - Bariatric FirmQuote™

  • Request Your Firmquote

    Completely confidential !
  • Client Status*

  • Welcome to Gorgeous Getaways. 

    We invite you to complete your medical history and upload your photos for your requested procedures. Once your file is complete, we will forward it to our bariatric surgeons and specialists for their assessment and price. 

  • Contact Information

    Please complete the information below
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  • Surgery Details

    Please tell us the procedures you are interested in

  • When you are planning to have your surgery done ?

  • Arrival Date:
     - -
  • Tentative Surgery Date:*
     - -
  • Departure Date:
     - -

  • Medical

    Please complete both the family and patient medical sections

  • Your Family Medical

    This information is very important for our Surgeons. Please indicate if you have a history of these conditions in your family. 

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

  • Your Personal Medical

    This information is very important for our Surgeons. Please indicate if you have any of the following. 

  • Heart Disease*
  • Diabetes*
  • Hypertension*
  • Deep Vein Thrombosis*
  • Cardiovascular Accidents*
  • Asthma*
  • Bleeding Tendency*
  • Hyperthyroidism*
  • Adrenal Insufficiency*
  • Hepatitis*
  • HIV*
  • Keloid Scarring*
  • Cancer*
  • Immunodeficiency Disorders *
  • Major Operations*
  • Drug Allergies*
  • Food Allergies*
  • Current Vitamins, food nutritional supplements*
  • Are you on current Medications and dosage?*
  • Ever been treatmented for depression, anxiety, bipolar or borderline disorders?*
  • If you have been treated for depression, anxiety, bipolar, or borderline disorders, can you provide a referral letter from your Psychiatrist ?*
  • Covid19 Vaccination Status*

  • Personal 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?

  • Photos or Files

    Please upload your photos securely.

  • Please upload your photos as per requirements.  Photos with clothing covering breasts, chest, abdomen, back or buttocks will not be accepted.

     

    PHOTOGRAPH INSTRUCTIONS

    The photographs should be digital, clear, in focus showing the full body – image size preferred to be 300 – 400 KB

    Photos should be captured up close at all angles, NO self-taken images with a mobile phone, as this distorts your position

    Plain white OR light-colored background with good lighting; No clutter in the background, please

    – If you are using a DSLR camera please try to keep each image less than 5MB.

    • Front view – shoulders to knees; arms slightly away from the torso
    • Rearview – shoulders to knees; arms slightly away from the torso
    • Left & Right side views - arms slightly away from the torso, shoulders to knees
  • Upload Files
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  • Hotel and Accommodations

  • In some of our destinations, we have excellent options in hotels, serviced apartments and recovery homes.  They are affordable and close to the hospitals/clinics.

  • Do you Need Accommodations?

  • Thank You for Completing!

    PLEASE SUBMIT BELOW WHEN COMPLETE.

  • We will contact you as soon as possible for confirmation. 

    In the meantime, let us know if you have additional questions.

    We look forward to have you as another member of the Gorgeous Getaways family around the world. 

  • More More Information please visit www.gorgeousgetaways.com

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