MEDICAL TOURISM

FILL IN THE FORM

Full Name:
Date of birth:
Email:
Phone number:
Appointment request date:
Type of surgery: MedicalPlastic SurgeryCosmetics
Description of health/Medical need:

Do you need air ticket? YesNo
*If yes provide us, the country you are traveling from
Your date of arrival:
Do you need a hotel reservation? YesNo
*If yes provide us, how many nights are you staying?
Any special accommodations are needed: Smoking roomNon smoking roomDouble bedSingle bed
Type of hotel: Boutique3 Stars4 Stars5 Stars
How many individuals will be traveling with you?
Do you need Meet & Assist? YesNo
Are you interested in visiting any of the touristic sites in Lebanon? YesNo
Do you need concierge assistance to help you with restaurant booking, general assistance, i.e. car rental or book a private car with a private driver,… YesNo
*If yes please specify: