In order our surgeon can respond you in a detailed manner, we need you send us your application via email by replying to the questioner that you will find below.

We beg you to respond thoroughly to each question, that will allow us to send you an accurate quote in shorter time and will enable our medical team to establish a precise medical diagnosis, and evaluate the possibility (or not) to carry out your surgery.
 

The easiest way to respond all the questions is to do a COPY / PASTE.
COPY all the questions and PASTE them into the mail you will send us.

You will have to send this form at:

info@sensualbodydream.com

      and/or
Sensualbodydream@hotmail.com


 

PERSONAL INFORMATION

Gender :
Last Name :
First Name :
Date of Birth:
Address:
City :
ZIP/Postal Code:
Country :
Profession/ Occupation:
Phone:
E-Mail :
Make sure that your email address is correct

INFORMATION CONCERNING TO YOUR SURGERY

1) Describe the plastic surgery or the combined plastic surgery package you would like:


2) Describe the dental treatment you would like:

YOUR PICTURES

To complete the questioner you can send us your photographs.

Required photographs:

For body surgery
Body photographs of Front, Back and Profile.

For Face surgery
Face photographs of Front and Profile – both sides.

To preserve your anonymity, and in case of face surgery, you can cover your eyes.
These pictures are indispensable for our surgical team to be able to establish a clear and accurate preliminary medical diagnosis.

MOTIVATION LETTER

How long have you wanted to have this type of surgery?


What are your reasons for having this surgery?


Have you previously consulted a plastic surgeon? If so, when and under what circumstances.


Why have you chosen have Sensual Body Dream to perform your surgeries?

When do you think you will arrive to Bolivia?

EXCURSIONS & TOURISM IN BOLIVIA

If you wish to make an excursion or trip in Bolivia, please tell us about the places you would like to visit.

YOUR STAY

In addition to the nights we include in your package, you may add extra stay.
How many days would you like to stay in Bolivia?


Would you want to stay at the Royal Lodge hotel or would you prefer to stay in another hotel?
In your package, we will include free nights at the Royal Lodge Hotel, however, you can choose one of the two other hotels that we offer for your stay. When we send you your quote, we will send you the extra cost if you want to stay at the hotel Best Western House Inn ***** or at the Camino Real hotel 5 ***** Luxury.


 

MEDICAL HISTORY FORM

Size:
Weight:
Maximum Weight?

Chest size:

Waist:

Do you smoke? If yes, how many cigarettes a day?

When did you start smoking?
Have you stopped smoking?
Since when?

Do you drink alcohol?
How often?

Are you using any kind of drugs or taking any medications?

Are you currently undergoing any treatment? If yes, which one?

Do you have any allergies? If yes, what are they?

Are you allergic to any medicines? If yes, what are they?

Others?

Are you diabetic?


Do you suffer from cholesterol problems?

Do you suffer from high blood pressure?

Do you suffer from anaemia?

Have you gone through depression?

Did you have any viral illnesses? If yes, which one?


Have you had surgical procedures before ? If yes, which ones?

Have you had cosmetic surgery ? If yes, which ones (part of your body)?

Gynecological and obstetrical History (only for women)
Number of pregnancies?

Number of children?

Number of caesareans?

Would you like to have more children? If yes, when?

In Case of Breast Surgery. What is your cup size?

Have you had mammography? If yes, when?

What was the result?

Have you ever had breast cancer?
Is there any family history of breast cancer? If yes, which member of the family?

    You will have to send this form at:

info@sensualbodydream.com

      and/or
Sensualbodydream@hotmail.com