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PERSONAL DETAILS

First Name *

Last Name *

Email *

Phone Number *

Postal Address *

Date of Birth (DD/MM/YEAR) *

Gender *

Male

Female

Other

Height (cm) *

Weight (kg) *

WL Book BMI

Surgery Details

Which surgery would you like? *

Gastric Sleeve

Gastric Bypass

Lap Band Removal

Revision Surgery (Sleeve to Bypass)

Revision Surgery (Lap Band removal to Sleeve)

Revision Surgery (Lap Band removal to Bypass

Trip Details

Which month would you like to travel? *

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Where do you want to have your surgery? *

Mexico

Thailand

Türkiye

Book me in for... *

Escorted (Trim Up group trip)

Go it Alone (Tim Up arranges your surgery and payment to hospital)

I would like ..

Standard Trip

Add on 4 days (selected dates throughout the year) Mexico Only

Companion

Are you bringing a companion? *

Yes

No

Companion - First Name

Companion - Last Name