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Thank
you for visiting the
Makeover
Travel
website.
In
order we can respond you in a clear, precise, and detailed manner,
please send us your application via email by replying to the
questionary that you will find below.
We beg you to respond thoroughly to each
question, that will allow us to send you an accurate quote in
shorter time and will enable our medical team to establish a precise
medical diagnosis, and evaluate the possibility (or not) to carry
out your surgery.
Please send us this form at:
contact@makeovertravel.com
and
makeovertravel@hotmail.com
The easiest way to respond all the questions is to do a COPY / PASTE.
COPY all the questions and PASTE them in the mail you will send us.
PERSONAL
INFORMATION
Gender :
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
INFORMATION
CONCERNING
TO
YOUR
SURGERY
1) Describe the
plastic surgery or the combined plastic surgery package you would
like:
2)
Describe the
dental treatment you would like:
3)
Describe the
laser treatment you would like:
YOUR
PICTURES
To
complete the questionary you can send us your photographs.
Required
photographs:
For
body surgery
Body photographs of Front, Back and Profile.
For Face surgery
Face photographs of Front and Profile – both sides.
To preserve your anonymity, and in case of face surgery, you can cover your
eyes.
These pictures are
indispensable for our surgical team to be able to establish a clear
and accurate preliminary medical diagnosis.
MOTIVATION
LETTER
How long
have you wanted to have this type of surgery?
What are
your reasons for having this surgery?
Have you previously consulted a plastic surgeon?
If so, when and under what circumstances.
Why have
you chosen have Makeover Travel to perform your surgeries?
EXCURSIONS &
TOURISM IN
BOLIVIA
If you wish to
make an excursion or trip in Bolivia, please tell us about the
places you would like to visit.
(For more information about our tourist packages, you can visit the
part of our web page that says Tourism Bolivia)..
YOUR
STAY
In
addition to the
nights we include
in your package, you may add
extra stay.
How
many days would you like to stay in Bolivia?
Would
you want to stay at the Royal Lodge hotel or would you prefer to
stay in another hotel?
In your package, we will include free nights at the Royal Lodge
Hotel, however, you can choose one of the two other hotels that we
offer for your stay. When we send you your quote, we will send you
the extra cost if you want to stay at the hotel Best Western House
Inn ***** or at the Camino Real hotel 5 ***** Luxury.
When do
you think you will arrive to Bolivia?
MEDICAL
HISTORY
FORM
Size
Weight
Maximum Weight?
Chest size
Waist
Do you smoke?
If yes, how many cigarettes a day?
When did you start smoking?
Have you stopped smoking?
Since when?
Do you drink alcohol?
How often?
Are you using any kind of drugs or taking any medications?
Are you currently undergoing any treatment?
If yes, which one?
Do you have any allergies?
If yes, what are they?
Are you allergic to any medicines?
If yes, what are they?
Others?
Are you diabetic?
Do you
suffer from cholesterol problems?
Do you suffer from high blood pressure?
Do you suffer from anaemia?
Have you gone through depression?
Did you have any viral illnesses?
If yes, which one?
Have you had surgical procedures before ?
If yes, which ones?
Have you had cosmetic surgery ?
If yes, which ones (part of your body)?
Gynecological and obstetrical History (only for women)
Number of pregnancies?
Number of children?
Number of caesareans?
Would you like to have more children?
If yes, when?
In Case of Breast Surgery
What is your cup size?
Have you had mammography?
If yes, when?
What was the result?
Have you ever had breast cancer?
Is there any family history of breast cancer?
If yes, which member of the family?
Please send us this form at
:
contact@makeovertravel.com
and
makeovertravel@hotmail.com
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