girl_wall_flowersDue to the exceptional pricing of our Breast Implant Surgery, we like to take the time to make sure you are a suitable candidate for surgery. The Surgical Assessment Form below helps us to make sure all health aspects are covered so we can get you booked for surgery and answer all your questions sooner!

All information entered below comes straight through to our surgeons email so he can make sure you are able to proceed and his lovely secretaries will be in contact to discuss booking a consultation. There is the option to attach photos of the areas you wish to be assessed, but this is not compulsory if you don’t wish to complete this part. This can be discussed with the surgeon during consultation.

It will take approx. 10-15 minutes to complete this form.

This form is completely confidential and will ONLY be seen by your surgeon, and medical consultant.

1Your Details
2Medical History
3Final Details
  • Your Details

  • MM slash DD slash YYYY