You can contact us by:

• filling in the questionnaire below
• sending an e-mail (office@mediconsult.pl)
• calling us at 0048 603 77 99 39

Courtesy title:	Mrs Mr Miss
First name:
Last name:
Country, City:
Telephone:
E-mail address*:
Year of birth:
What kind of medical services are you interested in?
I am interested in tummy tuck surgery
I am interested in other plastic surgery
Additional information / requirements / questions.
Preferable date of arrival:	YYYY-MM-DD
Length of stay:
How did you find us?	Google Google Ads Yahoo MSN Word of mouth Other
*E-mail address is obligatory.