Please take a few moments to fill in our form and provide essential information as indicated below. Accurate information is necessary for your health assessment. A false declaration may result in rejection of treatment and / or surgery by your surgeon at the time of consultation after your arrival. All the health records and photographs of patients are kept highly confidential to ensure complete privacy and anonymity of the patient.

When we receive your information, we will respond to your email within 24 – 48 hours. If you do not receive a response within 48 hours, please notify us.

Terms and Conditions:

  1. Your medical history is used for primary screening/evaluation before seeing our doctor. The doctor will decide whether to consider your medical history. If the patient was advised to visit their doctor for personal consultation and pre-operative tests and it was found out later that they were not a suitable candidate or they were not physically fit to have the surgery for any valid reason, the hospital/doctor has the right/authority to refuse the case.
  2. If the plastic surgeons advise/recommend the patient to see another doctor for additional consultation before the surgery and the patient refuses to do so, the attending plastic surgeon has the right to cancel the surgery. The patient will be charged for pre – check up costs as per the package price. For these reasons, the hospital/doctor/RBG will not be liable for the flight/travel, accommodation expenses of the patient during his/her trip.
  3. All submitted personal information and client expectations will serve as premilinary information for consultation only, and final results after surgery will largely depend on the client’s pre-existing structure and physique, which can be fully comprehended by a surgeon only upon actual consultation and physical examination at the hospital.


  • Patient Information

  • Person to notify in case of emergency

  • Initial Health Screening

    (please answer all questions yes or no)
  • 1. Your Family History

  • 2. Your Past medical history and treatment

  • 3. Current medications being taken

  • 4. Habit History

  • 5. Breast Surgery Information - If Applicable

    This is only required if you are having a Breast Augmentation procedure. Final details will be discussed with your Plastic Surgeon at your physical consultation.
  • Pre-Surgical / Anaesthesia

  • Have you or your immediate family members had any reactions?

  • Acknowledgement

    To the best of my knowledge, the questions on this form have been accurately answered. I understand that providing incorrect information can be dangerous to my health. It is my responsibility to inform Offshore Clinical of any change in my medical status. I also authorise the health care staff to perform the necessary pre-operative services I may need.
  • This field is for validation purposes and should be left unchanged.

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