Menu
home chirurgie esthetique en tunisieHome
interventions chirurgie esthetique en tunisiePlastic Surgery Procedures
chirurgie esthetique en tunisieClinic and surgeons
Accomodation chirurgie esthetique en tunisieAccomodation
Pricelist chirurgie esthetique en tunisiePricelist
Quote Request chirurgie esthetique en tunisieAsk for a quote
Contact chirurgie esthetique en tunisieContact
 
 
My Account
E-mail:
Pasword:
 
Password Forgotten

 
Ask for a quote
Personnal Information
  Sex:
 
Name :
  Surname :
  Age:
  Nationality:
  Address :
  Postal Code:
  City:
  Country:
  E-mail :
  Confirming E-mail :
  Profession:
  Telephone :
  Mobile:
  Fax:
  Password: (between 6 and 30 characters ):
Medical Information
     
  What is your present weight?
  What is the maximum weight you reached?
  What is your size?
 
  What size is your bra
(for breast related surgical operations) ?
  What bra size would you like to have?
 
  Do you smoke ? Yes No
  If yes, how many cigaresttes per day?
  If yas, since when ?
  Did you stop smoking? Yes No
  If yes, since when?
 
  Do you drink alcohol ? Yes No
  If yes, how frequently ?
 
  Are you taking any medicine?
Yes No
  If yes, what are they?
  Are you allergic to specific medical components? Yes No
  If yes, which ones ?
  Are you allergic to latex? Yes No
  Other allergies :
 
  Do you suffer from hypertension ? Yes No
  Are you diabetic ? Yes No
  Do you have cholesterol?
 Yes No
  did you ever have phlebitis ? Yes No
  Did you ever have a nervous breakdown? Yes No
  Do you have a viral or chronic disease? Yes No
  If yes, which ones ?
 
  Other medical elements to mention :
 
 

Do you user contraceptives?
If yes, which ones
 
  Did you get pregnant in the last six months: Yes No
 
Surgical Information
 
  Did you ever have a surgical operation ?
 Yes No
  If yas, whichone(s) and when ?
  Did you ever have a cosmetic surgey ?
 Yes No
  If yes, for what and when ?
The surgical operation you are interested in
     
  First choice you made
  Second choice you made:
  Third choice you made:
  Other possible surgical operations:
  For how long have you been determined to undergo the surgical operation of your choice?
  Did you ever meet a cosmetic surgeon for the purpose?
  If yes, what did he/she recommend?
  Reason behind the request for the operation:
   
  Airport of departure:
  When do you prefer to have your surgical operation?
(day/month/year)
   
 
The surgeon's preliminary diagnosis will be based on the information you provide in the medical questionnaires and your photos. These constitute your medical file, according to which you will be given a medical opinion and a quote. Please try to make your answers and comments as clear as possible in order to help us respond to your request with as mu_ch precision as possible.
 
Your photos
 
Our surgeons are in need of photos for the diagnosis and estimate.
 
  Photo 1 :
  Photo 2 :
  Photo 3 :

You may add more photos any time by connecting to your personnal account on the website.

 
  Enter code:
   
   
Try another code
The fields marked with are compulsory
Copyright © Chirurgie-Esthetique-Tunisie.net « Tous droits réservés »
Augmentation mammaire | Réduction mammaire | Lifting des seins | Liposuccion | Abdominoplastie | Rhinoplastie | Blépharoplastie | Lifting du visage | Pose d'anneau gastrique | Greffe des cheveux | Prothèses des mollets | Prothèses des fesses | Génioplastie | Chirurgie Réfractive des yeux | Lifting des bras | Lifting des cuisses | Vaginoplastie | Hyménoplastie | Réduction des lèvres vaginales | Cicatrices | IMPLANTS DENTAIRES | Implant avec couronne ( deux séjours de 5 et 7 jours) | Sinus lift ( 4 jours ) | Facette dentaire ( 5 jours ) | Blanchiment des dents | COURONNES | Céramo-céramique ( 5 jours ) | gynécomastie |