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TEL +27 315644150
FAX +27 315631462
JACQUELINE BIGWOOD
jackie@cosmedicholidays.com
CELL/MOBILE +27 836553680
BEATE DE KLERK
mailto:beate@southerncircle.com
CELL/MOBILE +27 836537258
PO Box 44
Hyper By the Sea
DURBAN/KWA ZULU NATAL
SOUTH AFRICA
4053
COSMEDIC HOLIDAYS INQUIRY FORM
Please complete the inquiry form and we will contact you with your required information.
I am interested in the following Surgery and Recuperation Package
Select a Package
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Falaza Game Park - Surgery and Recuperation
African Sensations - Surgery and Recuperation
Teremok Lodge - Surgery and Recuperation
Selborne Hotel - Surgery and Recuperation
I am interested in the following Surgery options:
Select a Procedure
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Breast Augmentation
Redo Augmentation
Breast Reduction
Breast Elevation
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Face Lift
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Plus Eye and Brow
Plus Upper and Lower Eyes
Plus Eyes or Brow
Brow Lift
Neck Lift
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Rhinoplasty(Nose)
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Abdominoplasty(Tummy Tuck)
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Liposuction - Abdomen
Liposuction - Hips/Thighs/Knees/Buttocs
Liposuction - Plus Abdomen
Liposuction - Neck/Arms or Ankles
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Dentistry
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Crowns
Bridges
Fillings
Abstractions
Root canal treatment
Teeth Whitening
Dentures
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Lasic Surgery
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Near and Short sightedness
Name:
Address:
Address:
City:
Province:
Country:
Email:
Telephone:
Please list any other questions you may have regarding additional procedures required or other Accommodation/vacation requests
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