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 vipps@vipps.kr. :)
Email address *
What is your full name? *
What is your gender? *
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
What is your age? *
What surgeries or treatments are you interested in? *
Why are you considering plastic surgery? *
Required
When are you planning to visit Korea for surgeries or consultation?
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
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