Online Consultation - Malik Abaci Aesthetics

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Our Solutions
- SURGICAL APPLICATIONS
  - BODY
  - FACE
- MEDICAL AESTHETICS
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Our Solutions
- SURGICAL APPLICATIONS
  - BODY
  - FACE
- MEDICAL AESTHETICS
Get a Quote
Contact

EN

TR

(+90) 533 134 71 32
(+90) 506 041 42 44

get a quote

Personal Information

Name - Last Name *Full name is required.

Date of Birth *You have to be 18 or older

What is your gender? *MaleFemaleUnspecified

Email Address *

Mobile Number *Our team will reach out to you via WhatsApp. Please provide your active WhatsApp number with country code. If you do not use WhatsApp, kindly select your preferred communication method from the options below.

Prefered Communication Method other than WhatsAppEmailVia CallOther (Telegram, Signal etc.)

If you've selected 'Other' in the previous question, please specify your **preferred** communication method.

Country *

Occupation

Marital StatusSingleMarried

Weight (in kilograms) *

Height (in centimeters) *

Please type which operation are you interested in *

Do you have a child? *YesNo

Are you pregnant or planning to become pregnant? *YesNo

Time passed since last childbirth? *

Time passed since last breastfeeding? *

Medical History

Do you have any medical condition? *YesNo

If you've selected 'Yes' to the previous question, please explain:

Diabetes *YesNo

Thyroid Disease *YesNo

Arthritis *YesNo

Kidney Disease *YesNo

Heart Disease *YesNo

Asthma *YesNo

Lung Disease *YesNo

Hypertension (High Blood Pressure) *YesNo

Stroke *YesNo

HIV *YesNo

Hepatitis *YesNo

Do you smoke? *YesNo

Stomach Ulcers *YesNo

Do you have sickle cell? *YesNo

Did you have any weight loss procedures/surgeries? *YesNo

Do you have anemia? *YesNo

Bleeding Disorders *YesNo

Autoimmune Disorders *YesNo

Use of Herbal Supplements or Vitamins *YesNo

Do you have any chronic diseases? *YesNo

If you've answered 'Yes' to the previous question, please explain

Have you had any previous surgeries? *YesNo

If you've answered 'Yes' to the previous question, please explain and include the date of surgery

Did you have any weight loss procedures/surgeries? *YesNo

If you've answered 'Yes' to the previous question, please explain and include the date of surgery

Do you currently use medications? *YesNo

If you've answered 'Yes' to the previous question, please explain

Do you have any allergies? *YesNo

If you've answered 'Yes' to the previous question, please explain

Do you have sickle cell? *YesNo

Do you have anemia? *YesNo

Have you been hospitalized in the past year? *YesNo

If you've answered 'Yes' to the previous question, please explain

Do you smoke? *YesNo

If you answered 'Yes' to the previous question please indicate the frequency:

Do you consume alcohol? *YesNo

If you answered 'Yes' to the previous question please indicate the frequency:

Do you have any mental health conditions? *YesNo

If you've answered 'Yes' to the previous question, please explain

Is there any other relevant information about your health that you wish to provide?All information you provide in this form will be kept confidential and used solely for medical evaluation purposes. We are committed to protecting your privacy and ensuring that your personal information is secure.

Final Details and Preferences for Your Procedure

What’s your desired date of operation?

Which one of these add-on services would you like?Hotel ReservationAirport Pick-upNone of Them

What is your choice of currency for payments and receiving quotes? *

Could you please share your estimated budget for the procedure? *

How did you hear about us?

To receive the 5% discount, kindly provide the name and surname of the referring patient, if applicable.If not, please skip this question

Please upload the pictures and videos of the body part you need treated. *

Drag and Drop (or) Choose Files

For optimal evaluation, please submit well-lit, 360-degree photos or videos taken only in your underwear. This will aid our doctor in assessing your suitability for surgery effectively. Ensure your face isn't visible. In the case of body procedures, kindly avoid covering the abdominal area. (Images or videos sent for breast surgery requests should be taken without a bra) Images will only be seen and kept secure by our doctor. Protecting your privacy and personal information is very important to us, and we strictly adhere to all applicable data protection laws. (Please leave blank if not applicable)

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(+90) 533 134 71 32 🇹🇷
(+49) 176 438 94 692 🇩🇪
(+90) 506 041 42 44 🌎
info@malikabaci.com

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