10% Off Surgery with BONUS

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Coupon Number
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Your Name* This field is required.
First Name
Last Name
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AddressWhere to ship your wearable device.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
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Angola
Anguilla
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Malawi
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Mali
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Mongolia
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Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
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Nigeria
Niue
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Turkish Republic of Northern Cyprus
Northern Mariana
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Palestine
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Peru
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Poland
Portugal
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Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
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Samoa
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eSwatini
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Tajikistan
Tanzania
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Isle of Man
US Virgin Islands
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Western Sahara
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Zambia
Zimbabwe
Other
Country
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Email* This field is required.
example@example.com
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Phone Number/Mobile/SMS* This field is required.We will not call without an appointment request
Country Code
Area Code
Phone Number
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CountryWhere are you travelling from?
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Have you ever travelled for cosmetic, dental or medical purposes
Yes
No
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Please provide an estimated surgery date?Maximum to December 2023.
Date
Month
Day
Year
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Hour
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50
Minutes
AM
AM
PM
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Select Your CurrencyYou will be invoiced a $250 reservation fee which will be deducted from your future package to freeze your price if you decide to book with us. If you choose another agency, you can still keep your Taqtik wearable and remote monitoring service, but lose your 10% discount. Please read all terms and conditions when you receive your coupon.
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Any questions or anything you wish to tell us!
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