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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
vipps@vipps.kr
. :)
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Email
*
Your email
What is your full name?
*
Your answer
What is your gender?
*
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?
*
Aesthetic shape
Asymmetrical shape
Functional issue
Minor improvement in shape rather than dramatic change
Complication from previous surgery
Foreign implant side effect from previous surgery
Obvious/fake looking shape from previous surgery
Other:
Required
When are you planning to visit Korea for surgeries or consultation?
Your answer
Is this your primary (first) surgery?
*
Yes, this is my first surgery. (Click if you never had surgeries before.)
No, this is my revision surgery.
Both, I am planning to have multiple surgeries. Some are primary and some are revision cases.
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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