Inquiry Form

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If you want to inquire about a procedure or have a general question, please fill out the inquiry form below. Filling out this inquiry form is the first of three simple steps on your way to achieving your beauty desires:

Complete inquiry form
Complete medical questionnaire form
Complete booking form

* Required fields.

First Name*:

Last Name*:

E-mail*:

Telephone:

Mobile:

Hygeia Healthcare can call me

Address*:

Postal Code:

City*:

State/Province:

Country*:

When are you planning to come?

pick a date..

What are you interested in?

Face	Body
Botox Chin Implant Eyelid Surgery Facelift Forehead Lift Nose Surgery (Rhinoplasty)	Breast Augmentation Breast Lift Breast Reduction Liposuction Tummy Tuck

*Gender Reassignment Surgery* Male to Female Female to Male	Combination Packages Mommy Makeover Total Makeover Body Lift

Other Dental Treatment LASIK Eye Surgery Hair Transplantation

Questions or Comments:

What is your main reason for seeking treatment abroad?

For those who cannot communicate in English, please select preferred language.

*** Please check your E-Mail or Junk Mail for our reply.

Contact Details:

Hygeia Healthcare
Unit 2 C-D, 2nd Floor Suanplu Corner Building
39/13-16 Soi Suanplu Sathorn Road
Thungmahamek, Sathorn District
Bangkok 10120, Thailand

Phone: + 66 26775662
Fax: + 66 26775663
Phone (From the UK): (+44) 020 8133 8346
Phone (From Denmark): (+45) 36953316
Phone (From USA): (+1) (323) 319-5865
Phone (From Australia): (+61)(02) 8006 2040

E-mail:

Hygeia Healthcare Co.,Ltd.