Affordable Plastic Cosmetic Surgery PRE-CONSULTATION FORM

Thank you for visiting the Makeover Travel website.  

To be able to respond to your application in a clear, precise, and detailed manner, please fill out all the fields in every stages of the following form.  

In addition to this form, you will have to send us the required pictures.

Required photographs:

Affordable Cosmetic Surgery For body surgery
Body photographs of Front, Back and Profile.
 Affordable Cosmetic Surgery  For Face surgery
Face photographs of Front and Profile – both sides.

These pictures are essential for our surgical team to be able to establish a clear and accurate preliminary medical diagnosis.

We will be pleased to respond to you as quickly as possible. 

Important: Only those including the required photographs and the Motivation Letter will be examined by our team.
All the information you supply to us will be treated with the strictest confidentiality.

If you have any problem to send us this Pre Consultation Form, you can contact us directly by email at: contact@makeovertravel.com

            Gender :

            M       F    

Last Name :

First Name :

 Date of Birth:

Address:

City :

ZIP/Postal Code:

Country :

Profession/
Occupation:

Phone:

E-Mail :


Make sure that your email address is correct


SURGERIES
 
FACIAL AESTHETIC SURGERY
 		   BODY AESTHETIC SURGERY  
       RINOPLASTY

BREAST SURGERY

  
        OTOPLASTY Breast Reduction
 

BLEFAROPLASTY

   Breast Augmentation   (implants included)   
 

Upper eyelids
 Lower eyelids
Breast Lift (hanging breasts) without implant
 
Upper + Lower eyelids Breast Lift (hanging breasts) with implants

 

   DERMOLIPECTOMY Arms

FACE LIFT

   DERMOLIPECTOMIY Thighs
Brow Lift + Eye Lift DERMOLIPECTOMIY Neck
Neck Lift      ABDOMINOPLASTY
Complete Face Lift
 

LIPOSUCTION/LIPOPLASTY

  

CHEEK
Cheek implant surgery

1 area2 areas3 areas

 

  

 Complete Liposuction

CHIN
reduction surgery		 GLUTEAL AUGMENTATION
 with implants

CHIN implant surgery

 GLUTEAL AUGMENTATION  Micro Fat Grafting Technique

   

VAGINAL LABIAPLASTY

 

HAIR TRANSPLANTS

Surgery Surgery Laser
   

VAGINOPLASTY
   

HYMENOPLASTY


DESCRIBE THE PLASTIC SURGERIES OR THE COMBINED PLASTIC SURGERY PACKAGE YOU WOULD LIKE:
 


DESCRIBE THE DENTAL SURGERY YOU  WOULD LIKE:


DESCRIBE THE LÁSER TREATMENT YOU  WOULD LIKE:
  
 


CHOOSE YOUR PROMOTIONAL PACKAGE



CHOOSE YOUR EXCURSIONS
Samaipata-El Fuerte Archeological           All Day
Samaipata - Cultural & Ecological            2D/1N
San Javier & Concepción Missions            All Day
San Javier & Concepción Missions            2D/1N
Che Guevara Routes                             2D/1N
City Tour o Shopping Spree in Santa Cruz    3H
Sand Dunes y Lagoons                             3H
Others excursions you would like


YOUR STAY

In addition to the 9 or 14 nights already included in your package, you may add extra stay.
 

Extra Nights:

Adults:

Children:


When do you think you will arrive to Bolivia?
 


Comments :
  
 

If you had scheduled your trip through a Travel Agency, or any other partnership, please fill in the boxes with the name and the "Agency Code" of your seller.

Name:
Code: