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Online Consultation Patient Form
Please fill out all the basic information for your detailed online consultation. Also, please send us clear photos of face or body to receive doctor's comments at :)
Email address *
What is your full name? *
Your answer
How would you like to be addressed? (Ms. Mrs. Mr. ..) *
Your answer
Please provide your contact phone number. If you have messenger application you use (WhatsApp / LINE / WeChat / KakaoTalk), inform us.
ex) Phone call and whatsapp : +82-10-1234-5678 / Kakaotalk: vipps
Your answer
What is your age? *
Your answer
What surgeries or treatments are you interested in? *
Your answer
Why are you considering plastic surgery? *
When are you planning to visit Korea for surgeries or consultation?
Your answer
Is this your primary (first) surgery? *
Have you had any filler injections before? If yes, please identify area, year, and brand of the injection. *
ex) Nose Bridge, May 2017, Restylane
Your answer
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