2023 - GG - Booking Form

Booking Form

Please try to complete all information required. If you have any questions or doubts please ask your Destination Manager directly, or Care Team Lead - Melanie Macgregor at melanie@gorgeousgetaways.com. For groups or clients travelling together, each patient must complete a seperate booking form.
Close Date

MonthDayYear
Date
Stage

Emergency Contact
Emergency Contact Information
Contact Emergency - *Status

Yes, please update following surgeryNo, please do not contactUndecided, will advise
Emergency Contact Name

First NameLast Name
Best Phone/Mobile Number

Country CodeArea CodePhone Number
Contact Email
example@example.com

Your Surgery Details
Note: Your surgery date will be confirmed prior and you will receive a separate confirmation with the surgery date confirmed by the hospital or clinic. If you did not receive this please request another copy from your booking manager.
Hospital/Clinic
Name of Surgeon or specialist
As per your surgery confirmation
Confirmed Surgery Date 1

MonthDayYear
Date
Confirmed Surgery Date 2

MonthDayYear
If having multiple surgeries.
What are Your Personal Goals for having Surgery

Hotel & Accommodation
Have You Booked Your Accommodation?

YesNoPlease Quote
Name of Hotel or Accommodation
Our preferred hotel or your own hote booking
Number of Nights
Early Check in?

YesNo
Late Check out?

YesNo
Number of Adults
Number of Children
Upload Your Hotel Booking & Insurance Information

If booking your accommodation through Gorgeous Getwawys, you will be provided with confirmation , invoice and receipt.
Cancelof
Any hotel or accommodation comments:

Booking Form