Plastic Surgery

Let's get started ...

Get Ready to Upload Your Photos! We will need photos of your front view, back view and each side view.

To give you an accurate quote, we'll need a few photos from you. Make sure you have them ready to upload when you finish this form.

Not sure what we need? Take a quick look at our photo guidelines before you get started!

https://info.trimup.co.nz/photos-page

First Name *

Last Name *

Email *

Phone *

Date of birth (DD/MM/YYYY) *

Gender

Male

Female

Other

Height (cm) *

Weight (kg) *

Desired Results

What country would you like a quote from? *

Thailand

Mexico

Turkey

Other

Previous Surgery

Have you had previous WEIGHT LOSS surgery? *

Yes

No

What year did you have weight loss surgery? *

What weight loss surgery procedure did you have? *

Gastric Bypass, Sleeve etc

How much weight did you lose? *

How much wieght have you regained? *

_____________________________

Have you had OTHER previous surgery? *

Yes

No

Details of previous surgery. *

If you have had previous surgery please provide details including year and procedure. If no previous surgery type 'none'.

Have you been hospitalised, had surgery or received medical care within the past 5 years (including cosmetic surgery)? *

If you have not been hospitalised type 'None'.

Do you have implants or metal objects in your body? Please specify *

If no metal objects or implants type 'None'.

Do you have difficulty with healing or scarring? *

Yes

No

Heath Issues

Please provide details of any heath issues you have specified above. *

If your do not have any of the health issues specified above type 'None'.

Have you ever had a Stroke or Transient Ischaemic Attack (TIA)? *

Yes

No

Do you have any allergies to food, drugs etc? *

If no issues type 'None'.

Do you Smoke or Vape? *

Yes

No

Do You Drink Alcohol? *

Yes

No

Medications & Vitamins

What medication do you currently take? Provide medication name, dose and frequency. *

Medication 1
Medication 2
Medication 3
Medication 4

Please provide details of any additional medications. Provide medication name, dosage and frequency.

List all vitamins or food/nutritional supplements you currently take and dosage. *

If no vitamins type 'None'.

Have you ever taken a MAO inhibitor such as Nardil, Marplan or Parnate? *

Yes

No

Have you ever taken daily Coumadin, daily Heparin or daily Aspirin? *

Yes

No

Pregnancy

Have you given birth within the last 12 months? *

Yes

No

Was the birth natural or C section? *

Natural (Viginal) Birth

Caesarean (C section)

Have you had a miscarriage or abortion in the last 12 months? *

Yes

No

Did you also have a dilation and curettage (D&C)? *

Yes

No

Other Details

Are there any other details we should be aware of?

Photos

We will need photos of your front view, back view and each side view.

Please upload photos *

To give you an accurate quote, we'll need a few photos from you. These will need to be your front view, back view and each side view. If you need further details on the photos click the link at the top of this form.