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Cosmetic Dentistry
Cosmetic Dentistry
Implants
Bridges
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Periodontic
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Hair Removal
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FAQ – Medical Spa
Aesthetic Surgery
Breast
Mommy Makeover
Tummy Tuck
Liposuction
Brazilian Butt Lift
After Weightloss
Before and After
FAQ – Cosmetic Surgery
Bariatric Surgery
Gastric Sleeve
Single Incision Surgery
Gastric Bypass
Mini Gastric Bypass Surgery
Duodenal Switch
Intragastric Ballon
Sadi-Surgery
Revision Surgery
Medical Form
Cuestionario Medico
Before and After
FAQ – Bariatric surgery
Medical Team
Dr. Eulices Frayre R.
Dr. Jaime Ponce de León
Dr. Jesús Santiago Sánchez
Dr. Gabriela Cueva Nungaray
Dr. Amanda Pérez Solano
Dr. Denisse Cueva Nungaray
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Send us the form with your information and we will get in touch with you soon.
The information received will be treated with full confidentiality.
Name
*
First
Last
Occupation
Age
Address
Address Lline 2
City
State / Province / Region
Email
*
Phone
*
Emergency contact name & phone number
In what surgery are you interested?
*
Gastric Sleeve
Single Incision G. Sleeve
Roux-en-y (gastric bypass)
Mini Gastric Bypass
Lap Band
Douodenal Switch
SADI surgery
Revision Surgery
Gastric Ballon
Mommy Makeover
Liposuction
Tummy Tuck
Body lift (after weight loss)
Breast augmentation/reduction/lift
Brazilian Butt Lift
Another surgery/ treatment
Your Measuraments
Weight
Height
Your goal Weight
For female patients only
Abortions
Birth Control Pills
List any past surgeries you´ve had:
Heart Diseases
Yes
No
Hypertension
Yes
No
Myocardial Infarct
Yes
No
Diabetes
Yes
No
Asthma
Yes
No
Lung or Breathing problems
Yes
No
Cancer
Yes
No
List all the medications you take every day for a chronic disease
Have you been diagnosed with:
Hepatitis
AIDS/HIV
Kidney Disease
Bleeding Disorder
Colitis (cronh)
Cancer
Multiplr Sclerosis
Others:
Drugs Allergic
Do you take this drugs?
Heparin
Cumarin
Warfarin
Aspirin
Tobacco use:
Yes
No
If yes, Hoy much?
Alcohol
Yes
No
Everyday
Message:
Message
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What is a Medical Spa?
Cosmetic Dentistry
Cosmetic Dentistry
Implants
Bridges
Crowns
Teeth Whitening
Dental Care
Endodontic
Periodontic
FAQ – Cosmetic Dentistry
Medical Spa
Spa Treatments
Facials
Massages
Capsula Infratherapist
Hair Removal
Aesthetic Medicine
Botox
Derma Fillers
Platelet Rich Plasma
Hyperbaric Oxygen Therapy
Varicoise veins
Before and After
FAQ – Medical Spa
Aesthetic Surgery
Breast
Mommy Makeover
Tummy Tuck
Liposuction
Brazilian Butt Lift
After Weightloss
Before and After
FAQ – Cosmetic Surgery
Bariatric Surgery
Gastric Sleeve
Single Incision Surgery
Gastric Bypass
Mini Gastric Bypass Surgery
Duodenal Switch
Intragastric Ballon
Sadi-Surgery
Revision Surgery
Medical Form
Cuestionario Medico
Before and After
FAQ – Bariatric surgery
Medical Team
Dr. Eulices Frayre R.
Dr. Jaime Ponce de León
Dr. Jesús Santiago Sánchez
Dr. Gabriela Cueva Nungaray
Dr. Amanda Pérez Solano
Dr. Denisse Cueva Nungaray
Blog
FAQ
Financing
Make Payment
Contact
