Booking | Makeover Vacations: For a Fulfilling Medical Holiday in Malaysia

All inquiries and information will be kept in confidence by our staff and will only be revealed to the attending surgeons/parties for the purpose of consultation and planning of your makeover program.

Name: *

Date of Birth: *

Gender: *

Telephone No: *

Cellphone No:

Fax No:

Email: *

Address: *

City: *

Zipcode/Postal Code: *

Country: *

Next of Kin

Name:

Relationship:

Contact Info:

Occupation:

Hobbies:

Height: * meters

Weight: * kg

Medical History

Are you being treated or have you ever been treated for any of the following?

Allergies: *

Anemia: *

Asthma: *

Blood Clots: *

Blood Pressure: *

Deep Vein Thrombosis: *

Diabetes: *

Drug dependence: *

Heart Problems: *

Hormone Replacement: *

Jaundice: *

Are you a smoker: *

Are you on any medication, if yes, please specify:

Booking Information

Arrival: *

Departure: *

No of Bedrooms: *

Preferred Accommodations: *

Package offered by MV, if any:

Choice of Procedure/Treatment

Please describe/specify the procedure(s) you wanted, if any

Medical/Health Scan:

General Surgery:

Surgical Cosmetic Procedure:

Non-surgical Cosmetic Procedure:

Dental Treatment:

Eye Refractice Surgery:

Fertility Treatment:

Others:

Choice of Surgeon(s):

Choice of Hospital/Medical Centre:

Other information:

Other information you would like us to know pertaining to your condition or holiday.

Agreement: *

I have read and agreed to the Disclaimer and ToS

Disclaimer
Terms and Conditions of Service

Preferred Payment Method: *

Important : Booking Requirements
Once the dates of your appointment with your Surgeons is furnished by MV, you will be required to pay a non-refundable deposit of USD100-00 to secure your bookings. Other terms may apply for special surgery packages offered by MV.

Makeover Vacations Sdn Bhd banking details:
Acc No : 2644 500000 3189
Bank : RHB Bank, Bangsar Branch
Swift Code: RHBBMYKL

If you choose Paypal, a link will be sent to your email requesting for payment.

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