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Last name: *
Family name
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Mobile number *
or your contact number. Please give dial code if outside Sri Lanka.
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Mobile messaging services:
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Nationality: *
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Consultation for Cosmetic Surgery | Preferred treatment:
Please select a treatment from the list below. If you have more than one please give details at the end of this form.
Consultation for SKIN treatments (Non-surgical):
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Medical Tattooing Treatments :
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Dental
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