Dr. Lanna – Quick Consultation "*" indicates required fields Step 1 of 6 16% Welcome to Seoul Cosmetic Surgery Thank you for your interest in our services. This consultation form will help us understand your needs and provide you with the most accurate information. The form takes approximately 3-5 minutes to complete. You can save your progress and return later if needed. Your information is secure and will only be shared with our medical team. Personal DetailsFirst & Middle name (as appears on your passport)*Last name (as appears on your passport)*Email Address* Phone (with country code)*Preferred Messaging App*WhatsAppKakaoTalkLineOtherYour ID or phone no. on selected messaging app*Gender* Male Female Other Date of Birth (YYYY/MM/DD)* Nationality (dropdown menu)*AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCity & Country of Residence*Preferred LanguageEnglishFrenchSpanishArabicOther Medical Trip InformationPlease tell us about the procedures you’re interested in.Desired Surgery/Treatment* Eyes Nose Face Contouring Two Jaw Surgery Anti Aging Deep Plane Facelift Breast Liposuction Fat Graft Stem Cell Filler or Botox Hair Transplant Dermatology Dental Miscellaneous Please explain in detail, what you would like to improve*Please be specific, e.g., Nose surgery with alar reduction, Eyelid surgery with Epicanthoplasty.Budget and TimelineWhat is Your Estimated Budget For Desired Surgery/Treatment?*Under $3,000 USD$3,000 to $5,000 USD$5,000 to $10,000 USD$10,000 to $15,000 USD$15,000+ USDWhen are you planning to have this procedure?*Within 1 month1 to 3 months3 to 6 months6+ monthsJust researching for now Medical InformationThis information helps us provide accurate recommendations and ensure your safety.Previous plastic surgeries (If any, when)?*Any major medical history / allergies (medical/dairy/etc.)*Medications Currently Used (If any)*If Liposuction or Tummy tuck is your desired surgery, please additionally write height (cm) & weight (kg) Travel PlanningHelp us understand your travel plans to KoreaVisa and Flight InformationDo You Need A Visa?* Yes No Have You Booked A Flight?* Yes No Flight Information*Arrival date in Korea* Departure Date from Korea* Accommodation and TourDo You Need Help Booking Accommodation?* Yes No What Is Your Hotel Budget?*Budget (Under $100/night)Moderate ($100-$200/night)Luxury ($200+/night)Your Perfect Tour ProgramWhen you come to Seoul, what tour would you be interested in (historical, Hallyu (K-pop/Kdrama) or shopping tour?Consultation and Surgery DatesDesired date/time of consultation* Desired date of surgery/treatment* Have You Contacted Clinics or Other Agencies ? If so, which ones?* Pictures of Affected Area(s)In Order To Get An Accurate Quote, it’s best to submit pictures if it is applicable. Please note that these pictures are solely for the purpose of consultation and to get a more accurate quote. (Each picture should show the whole face or body).Frontal*Max. file size: 256 MB. 45 Degree To The Left*Max. file size: 256 MB. Left Side*Max. file size: 256 MB. 45 Degree To The Right*Max. file size: 256 MB. Right Side*Max. file size: 256 MB. NostrilsMax. file size: 256 MB. For Rhinoplasty, please cock your head up, showing nostrilsAffected Body PartMax. file size: 256 MB. Affected Body PartMax. file size: 256 MB. Affected Body PartMax. file size: 256 MB. Affected Body PartMax. file size: 256 MB. Additional Comments Additional CommentsAgreement Agree All Information Submitted Via This Form is For Private Use only. It is for the sole purpose of getting a quote for your surgery/treatment. We will not rent, sell or utilize your Information in any way to third parties other than our clinics. You will receive various emails from us regarding your treatments, recommendations, and accompanying prroducts. By Checking the Box and clicking Submit; you acknowledge this.
