Surgery Medical Form

Please complete this confidential form for your FREE Surgical Assessment from one of our board-certified Plastic & Reconstructive Surgeons.


A false declaration may result in the rejection of surgery by the surgeon at the time of consultation after your arrival. Diabetes may affect and delay the healing and scar tissue of the skin, resulting in additional medical attention and hospitalization at additional cost to you, the patient.


Please note that a confirmed treatment plan can only be provided when you are examined by the Surgeon. All quotations provided are estimated costs of the procedure requested. All estimates given are subject to change.

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0416 109 417

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