Gorgeous Getaways - 2nd Opinion

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Name
First Name
Last Name
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Email* This field is required.
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Reason for 2nd opinion
Informed decision - I want more options
Informed decision - I want more options
I disagree with the assessment
I think the price is too high
My preferred surgeon was unavailable
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Preferred Destination
SELECT DESTINATION BELOW:
SELECT DESTINATION BELOW:
Alicante, Spain
Bali, Indonesia
Bangkok, Thailand
Barcelona, Spain
Cancun, Mexico
Chiang Mai, Thailand
Kaohsiung, Taiwan
Kuala Lumpur, Malaysia
Los Cabos, Mexico
Madrid, Spain
Malaga, Spain
Manila, Philippines
Merida, Mexico
Mexico City, Mexico
Monterrey, Mexico
Phuket, Thailand
Seoul, South Korea
Sevilla, Spain
Taipei, Taiwan
Tel Aviv, Israel
Tokyo, Japan
Istanbul, Turkey
Other choice
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If not provided/please indicate preferred destination
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Treatment Category
SELECT TREATMENTS BELOW:
SELECT TREATMENTS BELOW:
Addiction/Rehab
Aesthetic Treatments
Anti Aging Treatments
Bariatric and Obesity
Cardiology
Cosmetic Gynaecology
Cosmetic Surgery
Dentistry Treatments
Dermatology
Diagnostic & Imaging
Dialysis
Disease
Examination
Fertility and Reproductive
Gastroenterology
Gender Transition
General Surgery
Hair Restoration
Health and Wellness
Health Checks
Internal Medicine
Neurology
Oncology
Ophthalmology
Orthopedic - Bone and Joint
Otolaryngology
Regenerative Medicine
Rehabilitation Treatments
Skin Treatments
Specialty Treatments
Sports and Fitness
Stem Cells
Urology
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Preferred Hospital/Clinic
SELECT HOSPITAL/CLINIC BELOW: (if known)
Amerimed Hospital
Andrea Bariatric Surgery
AvantGarde Plastic Surgery Center
Bali International Medical Center (BIMC)
Bangkok Hospital HQ
Bangkok Hospital Phuket
Bangkok-Phuket Dental Center
Banobagi Clinic
BB Clinic
Beverly Wilshire Medical Centre
Brain Health Institute
Chaum
ChiroHealth Bangkok
Cirugía Plástica
Dr. Humberto Solis
Dr. Mark Shtern
Dr. Rafael Velasco
Dr. Ramon Navarro
Dr. Sergio del Hoyo
Dental Clinic
Dr. Mendez`s (SRS specialist) Center
Dr.Orawan Holistic Beauty & Anti-Aging Institute
Dr Andrea Bariatric Surgery
Hospital San José
ICER Plastic Surgery Mexico
Imperial Dental Specialist Centre
IS Dental Clinic
Istanbul Medikal Termal
JK Plastic Surgery
Kameda Kyobashi Clinic
Kameda Medical Center
Phuket Plastic Surgery Institute
Phuket Smile Signature
Playamed Hospital
Preecha Aesthetic Institute (PAI)
Prince Court Medical Centre
Samsung Medical Center Health Promotion Center
Severance Medical Checkup Center of Severance Hospital
Star Medica Hospital-Merida
Thanyapura Health
The Cabin Chiang Mai
VG Plastic Surgery
Victoria Hospital
Yanhee Hospital
Other not provided
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If not provided/please indicate hospital/clinic
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Preferred Surgeon (If Known)
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Preferred procedure: (LIST ALL)
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What are your expected outcomes?
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IMPORTANT: If you have not completed a Firmquote you will need to do so advance. This will confirm you are suitable for the procedure, the expected cost. and a surgery or treatment date can be tentatively scheduled at your request.

A Firmquote request can be complete here.
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Have you made travel arrangements?
YESNO
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Date of arrival
Date
Month
Day
Year
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Date of departure
Date
Month
Day
Year
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Requested Consultation date* This field is required.
Date
Month
Day
Year
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1
2
3
4
5
6
7
8
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10
11
12
Hour
30
00
10
20
30
40
50
Minutes
AM
AM
PM
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Are you planning to have surgery or treatment following consultation?
Yes
No
Undecided
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If yes, requested surgery/treatment date
Date
Month
Day
Year
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Please provide any additional comments
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Do you give us permission to share your medical information with another surgeon or treatment specialist?
YESNO
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Patient Confirmation (please sign)
Clear
Should be Empty: