My Medical Vacations - Cosmetic Firmquote

Request Your Firmquote
Thank you for requesting a Firmquote! If you have already submitted your medical and photos for a previous request you can bypass medical and photo sections by marking (YES) as we will access your previous file information. Otherwise, leave as (NO), and complete all sections. Completing all information will allow your surgeon/specialist to make a thorough assessment and confirm your pricing if any adjustments required. Feedback can take from 1 to 5 days depending on surgeon/specialist availability.
Have you requested a Firmquote prior? (Can be other destination)

No, this is my first request Yes please reference my existing patient file
How do you plan on travelling? (Can change at anytime)

I plan on travelling by myself I plan on travelling with a friend, partner, or family I plan on travelling with a group I plan to meet others patients travelling
Contact Information

Please complete the information below
Name

First Name Last Name
Patient Gender
Patient Birth Date

Month Day Year
Age
Nationality
Height
Weight

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

Area Code Phone Number
Mobile Number

Area Code Phone Number
E-Mail *

Surgery Details

Please tell us the procedures you are interested in
Preferred Destination
Requested Procedure(s)
Requested Procedure(s)
Requested Procedure(s)
If not mentioned above please add treatments
What are Your Personal Goals for having Surgery
Anything you want to ask or tell the surgeon?
Requested Date of surgery (If Known)

Month Day Year
Date
Arrival Date (If Known)

Month Day Year
Date
Departure Date (if known)

Month Day Year
Date

Photos or Files

Please upload your photos securely.
Please upload your photos or requested files. These will be sent to the surgeon for a FIRMQUOTE and customized feedback. Feedback can take up to 5 business days.

The following are guidelines for submitting photos that are widely accepted by all our hospitals and service providers.

Requirements For Breast Surgery Photos:
For clients requesting any type of Breast Surgery, the following additional requirements are needed for our surgeons to make a more informed decision on suitability as a candidate for surgery. We also require your current Bra Cup size and the Size you wish to be post-surgery
- Front view which includes the neck, shoulders, breasts and the navel.
- Front view with both arms raised above the head.
- Front view with both arms raised above the head, body leaning or slightly bent forward assuming a diving position.
- Left and Right Side view with both arms down the side, as if standing to attention.
- Left and Right Side view with both arms raised above the head, body leaning forward or slightly bent forward assuming a diving position.
Facial Photos must include:
Left Profile
Right Profile
Front On
Head Tilted Backwards
Head Tilted Downwards

Rhinoplasty Photos must include:
Left Profile
Right Profile
Front On
Head Tilted Backwards
Head Tilted Downwards

Tummy Tuck Photos must include:
Left Profile
Right Profile
Front On
Back On

Thigh Lift Photos must include:
Left Profile – Showing Inside Thigh
Right Profile – Showing Inside Thigh
Left Profile – Showing Outside Thigh
Right Profile – Showing Outside Thigh
Front On
Back On

Arm Photos must include:
Left Arm Raised At Side Of Body
Right Arm Raised At Side Of Body
Photo/File Upload

Upload Files

Cancel of

Hotel and Accommodation
We have excellent accommodation options in both hotels or serviced apartments. Our preferred accommodation options are specially selected to suit the medical traveler. They are close to the hospitals/clinics, are well priced, and close to amenities. All accommodation is priced for 2 people, including breakfast for 2. Additional options for families and large groups.
Do you Need Accommodation?

Yes, Please quote No, already booked Undecided, will get back
Number of Nights
Please advise your itinerary if staying in a non-preferred hotel.
Thank You for Completing!
We will forward this information to your surgeon for review and feedback. In the interim please let us know if you have any questions.
Should be Empty:

Request Your Firmquote

Contact Information

Surgery Details

Medical

Habits

Women

Photos or Files

Hotel and Accommodation

Thank You for Completing!