BOOKING AND MEDICAL HISTORY FORM

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DISCLAIMER (Click to download)

You must send the completed forms to: info@surgicalescapes.com

You will be required to complete and sign a Booking Form, Medical History Questionnaire together with our Disclaimer once you have made your final decision. Within these application processes you will also have the possibility to choose your accommodation, plan your holiday and or spice up your itinerary with a variety of exciting activities like colorful city tours, pampering beauty & spa therapies and relaxing outdoor adventures. As soon as your medical agenda has been finalized you will also receive a detailed travel itinerary.

Together with the enquiry/application form please supply us with close up and clear digital photo(s) in color of the area(s) of your body requiring surgery.

(If you have not received any reply from us within 3 days after your enquiry/application, please contact us again. There might have been a server/Internet problem)