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Hello good day!

First, I want to thank the Glad we contacted and your interest in our procedures and services.

I want to assure you that I have a professional team offering over 12 years of experience, trust, confidence and support throughout the process as an added value in order to provide our users a quality service making your process beautification a satisfying experience.

We could collaborate by filling out a form that I relate below and photos of front and improve the area you want to make a more objective assessment and budget profile.



Means by which you heard about Dr.

City and country residence

Document ID

Surgery (s) in which they are interested:




What is your dress size?



Do you smoke?
Si No 

If yes, number of cigarettes per day?

From what age?

Have you stopped smoking?
Si No 

Since when?

Use alcohol?
Si No 

How often?
Do you use any medication?
Do you currently follow any treatment?

If yes, since when?

Do you have any allergies?
Si No 

If yes, what?

Do you suffer from diabetes?
Si No 

Do you suffer from cholesterol?
Si No 

Do you suffer from hypertension?
Si No 

Do you suffer from anemia?
Si No 

Have you been practiced surgery?
Si No 

If yes, what / which ones?

Did they have some sort of cosmetic surgery?
Si No 

If yes, what / what?

Number of pregnancies?

Number Of children?

Number Of cesarean?

Do you want to have more children?
Si No 

If yes, How long? Have you had a mammogram?

If yes, how long ago?

Have you had breast cancer?

Do you have a family history of breast cancer?
Si No 

Would have applied Botox?
Si No 

Would have applied Polymers?
Si No 

Have you done Mesotherapy treatments?
Si No 

Are you pregnant?
Si No 

Date Return Date probable that you want surgery?
Si No 

Attach Pictures

I look forward to their data and photos to send the budget. Additional if needed, I will send the accommodation options we recommend for you according to your tastes, needs and budget choose an option.


Paola Valderrama
Department of Marketing
Dra. Nora Beatriz Sánchez
Plastic and reconstructive surgeon certified
Centro Medico Imbanaco A office tower 904
Office Phone: 558 4322 - 682 1000 ext 1904
Cali - Colombia