Gorgeous Getaways - Bariatric FirmQuote™

Request Your Firmquote

Completely confidential !
contact type
Leadsource
Lifecycle stage
record type
Lead generator
Lead Source
Medical Received
Client Status*

This is my first inquiryNew Quote Request. Please use existing file information
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.
Name*

First NameLast Name
Patient Gender*
Patient Birth Date*

MonthDayYear
Age*
Nationality*
Height*
Weight*
Do you have any underlying Health Issues?
Do you have sleeping apnea? Or Breathing problem? If you do have, how long you are you using CPAP machine?
Have you had any past sleeve gastrectomy, gastric or any kind of surgery/procedure before?
Contact Information

Please complete the information below
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Mobile Number*

Area CodePhone Number
E-Mail*

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
Photo/File Upload

Upload Files
Please upload any local medical information as well as a recent blood test. Cancelof

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?

Yes, Please quoteNo, already bookedUndecided, will get back
If yes, choose your Accommodations:
Number of Nights
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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Request Your Firmquote