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Please ensure you have your photographs ready to be attached prior to filling out the Online Assessment Form.
Please TICK if your family has or currently have had any of the following
IMPORTANT NOTE: Information below is important for your Surgical Recommendation. If you are under medical care, please state all condition/s current and pre-existing. The Surgeon may request further information &/or your medical professionals’ letter stating you are fit for surgery, before any final evaluation is given. Omitting any information could result in surgeon rejecting surgery at the time of face-to-face consultation.
PHOTOS ARE REQUIRED to obtain a surgical / dental recommendation from a surgeon. Make sure you have looked at the correct examples which are found here on: Assessment Form Page.
IMAGE LOADING: If you are having problems uploading your images onto this form, submit the form and email images separately to: firstname.lastname@example.org
Please note that any false declarations in relation to any of your medical conditions or history may result in; the Surgeon rejecting surgery at the time of your consultation after your arrival at the Hospital and/or additional costs to the patient if there are any post-surgery complications that require additional medical attention and hospitalisation due to omissions in information.
**Restored Beauty Getaways Policy: All personal information is confidential and is not released to any other individual, party, individual or organisation without the consent of the Client. Also please refer to the Website Restored Beauty Getaways Terms and Conditions with Disclaimer. Full Terms and Conditions with Disclaimer will be issued upon acceptance of surgery after evaluation has been received.
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