Cosmetic surgery (plastic surgery) and dentistry in Costa Rica

 

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Procedures:
tummy tuck
breast enlargement
breast reduction
face lift
hair transplant
eye lid surgery
ear surgery
fat transfer
neck lift
arm lift
liposuction
thigh lift
lower body lift
nose surgery
lip embellishment
male breast reduction
gastric bypass

Cosmetic surgery medical questionnaire


Privacy Policy
Your privacy is important to us! Any information collected through our questionnaire will be used solely for the purpose of providing you with complete and accurate information, and the best recommendations possible regarding your surgical options. All information is held in strict confidence and is not shared with anyone outside of our medical staff.

* Required Information
* First & Last Name
* Email address
* Phone
*City
* State/Province
* Country
* Age
* Sex Male   Female
* Height ft. in.
* Weight lbs.
What type of cosmetic surgical procedure do you wish to have?

Face Lift
Eye Lift
Nose
Chin Implant
Ears
Neck Lift
Tummy Tuck
Breast Lift
Breast Implant/Augmentation
Arm Lift
Thigh Lift
Lower Body Lift *
* Includes tummy tuck, buttocks lift, and lateral thigh lift

Buttocks Lift
Brow Lift
Forehead Lift
Lip Embellishment
Male Chest Reduction
Hair Transplant
Chemical Peel
Dermabrasion
Fat Transfer to Face
Fat Transfer to Hands
Fat Transfer to Under Eyes
Fat Transfer to Other
If Other please describe

Fillers
Botox

WEIGHT LOSS SURGERY:

Mini Gastric Bypass
RNY Gastric Bypass
Gastric Sleeve
Lap Band

LIPOSUCTION, check all that apply:

Upper and Lower Abdomen
Love Handles
Hips
Arms
Inner Thighs
Outer Thighs
Back Rolls
Bra Line
Other
If Other please describe

DENTAL:
Please explain what you need for dental:

*Anticipated Date of Surgery:  

If you do not see the procedure you are interested in please ask in the comment section below.

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