H E A L T H   Q U E S T I O N N A  I R E

Please give us some basic information about your medical history along with the procedure (s) you have in mind, and we will reply with further details and a price quote.
 
It is not necessary to send us photos.  We respect your privacy and understand the inconvenience of sending sensitive photos by email.  You may, of course, provide one if you wish and if so, our email address is aarguello@arrivacostarica.com
 
Upon receiving your Medical Questionnaire, Dr. Arguello will determine the scope of your requested surgery and send an estimate through our patient coordinator.  You may rely on this estimate as being accurate and factual.  Later adjustments to the quote can always be made by mutual agreement with Dr. Arguello during your pre-op examination, but the price quoted by email will always be our correct price for the procedure.
 
If you arrive early enough in the day, you may have your pre-op consultation the same day of arrival.  Otherwise, you can settle in the recovery inn and see us the next day.  Initial consultations are generally in the late afternoon.  Your surgery will usually be performed the next day.
 
You will need a medical checkup prior to your procedure and you may have it done either at home, or here at our hospital.  We have complete facilities to do all required medical tests quickly and at a nominal cost at the time of your pre-op consultation.

First name:      Last name:

Email:

Sex:     Male       Female

Age:    yrs.

Weight

Height 

What type of cosmetic surgery interests you?:

Abdomen                      Ears

Arms                             Eyelids

Breast Augmentation     Face

Breast Reduction           Neck

Buttocks                       Nose

Chin                             Thighs

Other:

Please list any previous surgeries with dates:

How is your general health?:      Excellent       Good    Fair    Poor

Do you have any particular health problems? If yes, please explain:

Any allergies? ( please specify ):

Any negative experience with anesthesia?. If so, please explain:

Medicines you take at present:

Do you use tobacco?

Please list below any specific comments or questions you may have:

Please give us a preferred date and a secondary date, if possible, for your procedure:

Preferred date:

Secondary date:

Thank you. We will promptly replay with answers to any questions you may have, a general overview of your requested surgery, a price quote, and availability of your requested dates.

Dr. Alberto Arguello, MD. Co-chairman, Plastic and Reconstructive Surgery Department, Clinica Biblica Hospital, San Jose, Costa Rica.  2005 ArrivaCostaRica.com.  All rights reserve