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Enquiry Form

Please fill out bellow form and check any procedures you are interested in.

*Frist name: 
*Last name: 
Address:
City:
State:
Country:
Zip:
Phone:
*E-mail:

Plastic surgery:

Face

Botox injection
Brow lift
Chin augmentation
Eyelid surgery
Face lift
Forehead lift
Nose augmentation (nose enlargement)
Nose reduction
Prominent ears

Breasts

Breast augmentation (breast enlargement)
Breast lift
Breast reduction

Body

Abdominoplasty (tummy tuck)
Liposuction
Scar revision
Sex Reassignment Surgery

 

Dental services:

Cosmetic dental care

BriteSmile teeth whitening
Ceramic inlays
Ceramic onlays
Dental veneer
Tooth colored fillings

Dental health

Bridge
Cleansing and polishing
Crown
Dental checkup program with X-ray
Dental implant
Denture
Gum surgery
Root canal treatment

 

Specialised medical services:

Lasik
Coronary artery bypass surgery
Joint replacement
Knee joint replacement
Hip replacement

 

Other treatment or any questions you might have:

 

When would you like the have the treatment?:

 

How did you here about us?:
Adverts
Friends
Etc.
Search engines

 

 

 
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Breast augmentation patients get to stay 3 nights free at the Ambassador Hotel if they have it done in Bangkok before end of November 2007.

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