Online Form
* - Indicates required fields
Personal data
Title:
*First name:
*Last name:
Sex:
Male
Female
Date of Birth (dd/mm/yyyy):
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*Nationality:
Post Code:
Address:
City:
*E-mail:
*Phone Number
Job Title
Travel Info
*Estimated Date of Travel:
Please Select
As soon as possible
within the next 2 months
within 6 months or later
for information only
Exact Date/Time:
Package
Please Select
4 night
7 night
10 night
14 night
21 night
Dentistry
Dental Work Required:
Please Select
my teeth are healthy - I need cosmetic dentistry only
There is a lot to do - I need a complete plan
a few small correction
I am not sure - My teeth have not been checked for some time
Do you have a quote/proposal from a dentist?
Yes
No
I attach my Panoramic X-ray now:
Are you interested in:
Please Select
Consultation, plan and price calculation
Consultation, plan, price calculation and small treatments
Immediate treatment of whatever comes up
What kind of treatments would you like?
Dermatology
What type of cosmetic treatments are you interested in while you are here?
Please Select
Laser surgery
Vein Treatments by Laser
Mesotherapy
Wrinkle Filling
Botox
Permanent Hair Removal
Other
Plastic Surgery
What parts of the body are interested in the treatments?
What kind of treatments would you like?
I attach my photo now:
Accomodation booking
Accomodation needed
Yes
No
Select your hotel:
Please Select
Polus Palace Thermal Golf Club Hotel *****
Andrássy Hotel *****
Zara Boutiquehotel ****
Hotel Parlament ****
Hotel Molnár ****
Type of rooms:
Single
Double
Triple
Reservation for:
person
Other informations
*Where did you hear about us?
Please Select
Youtube
Internet
E-mail
From someone who has traveled with Aesthetic
From a travel agency
From our brossure
Other
In detail:
Questions, comments:
Finally all you need to do is to book tickets and inform us about the exact date of your arrival. A representative of our company will meet you and accompany to the place of your stay and to any of the practices.
We are looking forward to meeting you!