Gorgeous Getaways - a comprehensive range of packages to transform body, mind and spirit.

Booking Form

Please complete the following form for your holiday and treatments. Please give as much information as possible in all cases, especially your health and medical history.

All people having surgery is required to fill in the following forms. If you are travelling with another who is having surgery, please ensure that you forward this form to them to fill in.

All bookings must be accompanied by payment for accommodation, which can be paid by credit card or direct transfer. Payment for all surgery and dentistry treatments is payable direct to the hospital after the consultation with the surgeon, when you are happy and agree to go ahead.

ALL FIELDS ARE COMPULSORY FOR BOOKINGS:	I would like to book my surgery holiday:
First Name:
Last Name:
Email address:	(please note: with Hotmail, Yahoo or AOL accounts, our response to you may be directed to your Bulk folder. Please can you Whitelist "info@gorgeousgetaways.com" in your account, and also specify an alternative account for these addresses)
2nd email address if you have one:
Phone:
Mobile Phone:
Street Address:
City:
State/Province:
Postcode:
Country:
Date of birth: (dd/mm/year)
Age:

Next of Kin:
Next of Kin Name:
Next of Kin contact (email address or phone):
Next of Kin relationship:
Would you like us to update this person of your surgery and health while you are on holiday?	Yes, Please contact

Where did you hear about Gorgeous Getaways?:

Your Surgery:
Who is the Surgeon/Hospital you would like to book with?	* Hints for choosing the right location and surgeon for you
Your Surgery Treatments:
If your surgery treatments are not listed above, please list your surgery and other treatments (dentistry, optical etc.):
What are your personal goals of having surgery?

Your Holiday:
What is the Holiday Accommodation Package you would like to book:
Platinum Service Package:
Read more about the Platinum Service Package here
Number of Adults travelling:
Number of Children travelling:
Name of other people travelling:
Arrival date (DD/MM/YEAR):
Departure date (DD/MM/YEAR):
How many days:
Flight arrival time:
Flight arrival airline and number:
Flight departure time:
Flight departure airline and number:

What are the most important factors for you on your surgery holiday? (you can choose more than 1 by holding down the CTRL key)
Do you have any other questions or requests?

(Next step: Medical questions)