Pre-Consultation Form

Please complete all sections of the Pre-Consultation Form and provide clear, high-quality photos. This information is essential for us to provide an accurate medical assessment and a personalized quote that suits your needs.

NOTE: All information provided will be handled with strict confidentiality.

PERSONAL INFORMATION

Name:

Age:

Phone (Cell phone / Home):

Address:

City:

Country:

Email:

SURGERY INFORMATION

Describe the Procedure(s) you would like to perform:

Upload your Photos:

Required photos:
Body Surgery: Front, back, and profile (no face photos needed).
Face Surgery: Front and both side profiles (no body photos needed).

MOTIVATION LETTER

1. How long have you been considering undergoing this type of surgery?

2. What motivates you to pursue this surgery?

3. Have you consulted with a plastic surgeon before? If yes, when and under what circumstances?

4. Why did you choose Med Tour Plastic Mexico for your procedure?

ARRIVAL DATE

1. When do you plan to arrive in Mexico? (Please provide a specific month or date so we can check availability).

2. How many days can you stay in Mexico? (Depending on your procedure, a stay of 7 to 15 days may be required to ensure proper recovery).

3. The PortoNovo Hotel & Suites 4**** is included in your package. Would you like to upgrade to a different hotel for an additional cost?

4. Are you interested in excursions or tourist activities in Mexico? If yes, please share which places you’d like to visit.

GYNECOLOGICAL AND OBSTETRICAL HISTORY (WOMEN ONLY)

Number of pregnancies?

Number of children?

Number of caesareans?

Would you like to have more children? If yes, when?

In Case of Breast Surgery What is your cup size?

Have you had mammography? If yes, when? What was the result?

Have you ever had breast cancer? Is there any family history of breast cancer? If yes, which member of the family?

MEDICAL HISTORY

Height:

Weight:

Maximum Weight (ever):

Chest Size:

Waist Size:

Do you smoke? If yes, how many per day?

Do you drink alcohol? If yes, how often?

Are you taking any drugs or medications? If yes, please specify.

Are you undergoing any treatment? If yes, which one?

Do you have allergies? If yes, please list.

Are you allergic to any medications? If yes, please specify.

Other health issues (if any):

Are you diabetic?

Do you have cholesterol problems?

Do you have high blood pressure?

Do you have anaemia?

Have you experienced depression?

Have you had any viral illnesses? If yes, which one?

Have you undergone any surgeries before? If yes, which ones?

Have you had cosmetic/plastic surgery? If yes, which procedures?

Download and Submit Your Pre-Consultation Form

If you prefer, you can download our Pre-Consultation Form as a PDF, fill it out, and send it back to us via email. This allows you to complete the form at your convenience. Simply download the file below, fill in the required details, and email it to contact@medtourplasticmexico.com

Contact Us

Have any question?
Get in touch

Reach out to us with any questions or concerns. We're here to help!

Pre-Consultation Form

Download and Submit Your Pre-Consultation Form

Contact Us

Have any question? Get in touch

Have any question?
Get in touch