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Medical Form

 

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 by your dentist 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:

  • 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/clinic/doctor has the right/authority to refuse the case.
  • If the dentist advise/recommend the patient to see another doctor for additional consultation before the surgery and the patient refuses to do so, the attending dentist has the right to cancel the procedure. 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.

All submitted personal information and client expectations will serve as premilinary information for consultation only, and final results after the procedure will largely depend on the client’s pre-existing structure and physique, which can be fully comprehended by a dentist only upon actual consultation and physical examination at the hospital/clinic.

Medical Form - DG

  • Patient Information

  • DD slash MM slash YYYY
  • Person to notify in case of emergency *

  • Initial Health Screening

  • 1. Your Family History

  • 2. Your Past medical history and treatment

  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • 6. Current medications being taken

  • 7. Habit History *

  • 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 Dental Getaways/Hospital/Clinic of any change in my medical status. I also authorise the health care staff to perform the necessary pre-operative services I may need.
GROUP TRAVELfrom $1,800 

GROUP TRAVEL

We offer escorted group travel, accompanied and hosted by a Dental Getaways member for added assurance.

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GOING SOLOfrom $1,500 

GOING SOLO

Are you considering traveling on your own? Dental Getaways will coordinate every aspect of your itinerary.

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Dental Getaways

Dental Getaways is Australia’s ‘Leading Dental Tourism Agency’ and primary provider of premium international dental holidays. Our consultations are available worldwide, inviting discussions and enquiries as to the many dental procedures available.

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Restored Beauty Getaways is Australia and New Zealand’s ‘Leading Medical Tourism Agency’ and primary provider of premium international rejuvenation holidays and affordable procedures (with extraordinary results) to you, our clients.

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