Virtual Consultation


Getting started with Jungceylon Plastic Surgery Clinic is easier than ever via our Virtual Consultation form. From the comfort of your own home, you can provide us with essential information to help us evaluate your candidacy for the procedures that interest you.

Please take the time to fill out this form as completely and accurately as possible.
 
indicated required fields
Procedure:
Title Name: Mr.      Miss.     Mrs.
Full Name:
Email:
Phone/Mobile: - -
  Country Code - Area Code - Number
Requirement :
MEDICATIONS
Are you sensitive
or allergic to:
Medical History:
Operate History :
(where)
 Patient Medical Conditions
Heart Disease:
Diabetes:
Hypertension:
Deep Vein Thrombosis:
Cardiuvascular Accidents:
Asthma:
Bleeumg Tendency:
Hyperthyroidicm:
Adrenal Insuffciency:
Hepatitus:
HIV:
Keloid Scarring:
Cancer:
Major Operation:
Other:
Underlying Disease:
Drug Allergies:
Food Allergies:
Current Medication and Dosage:
Current vitamins, food nutrional supplements:
Have you ever been treated for depression:

Quick picture for virtual consultation

Photo 1:
Photo 2:
Photo 3:
 

Advanced picture requests for virtual consultation

Group I (General Facial pictures) for Forehead or Brow Lift Surgery ,Face Lift and ,Neck Lift Surgery ,Eyelid Surgery ,Facial Implants ,Surgery ,Female ,Feminization Surgery(FFS) ,Chin or Cheek ,Augmentation Surgery ,Lip Augmentation ,Surgery ,Under chin ,Liposuction Surgery.
Forehead lift or Brow lift
Face lift
Neck lift
Blepharoplasty (Eyelids Surgery)
Facial Implants
Facial Feminization Surgery (FFS)
Chin or Cheek Augmentation
Lip Augmentation
Underchin Liposuction

use General Face pictures : which are

A) Front view
B) Right and Left Oblique view
C) Right side and Left side view
 

Right Oblique View

Frontal View Left Oblique View

Right Side View

Left Side View

Photo 1:
Photo 2:
Photo 3:
Photo 4:
Photo 5:
 


Group II (Special Facial pictures) for Rhinoplasty or Nose Surgery ,Otoplasty or Ear Surgery
Augmentation or Reduction Rhinoplasty

use Special Face pictures : which are

A) Front view
B) 45 degree right and  45 degree left view
C) Right side  and Left  side  view
D) Basal  view
 

Right Oblique View

Frontal View Left Oblique View

Right Side View

Left Side View

Basal View
Photo 1:
Photo 2:
Photo 3:
Photo 4:
Photo 5:
Photo 6:
 

Otoplasty (Ear Surgery)

use Special Face pictures : which are

A) Front view
B) Right side  and Left  side  view
D) Back view
 

Front View

Back view

Right Side View Left Side View
Photo 1:
Photo 2:
Photo 3:
Photo 4:
 

Group III (Breast or Chest pictures) for Breast Augmentation Surgery ,Breast Lift Surgery , Breast Augmentation with Lift Surgery ,Breast Reduction(Female) Surgery ,Male Breast Reduction Surger ,Liposuction of Chest Surgery
Breast Augmentation
Breast Lift
Breast Augmentation with Lift
Breast Reduction (Female)
Male Breast Reduction
Liposuction of Chest

use Breast or Chest pictures : which are

A) Front view
B) Right Oblique and Left Oblique view
C Right side and Left side view
 

Right Oblique View

Frontal View Left Oblique View

Right Side View

Left Side View

Photo 1:
Photo 2:
Photo 3:
Photo 4:
Photo 5:
 

Group IV (Liposuction pictures) for Liposuction Surgery
Chest

needs :  

A) Front view of Chest or Upper body
B) 45 degree right and 45 degree left view
C) Right side and Left side view
 
Photo 1:
Photo 2:
Photo 3:
Photo 4:
Photo 5:
 
Abdomen ,Hip and lovehandles

needs :  

A) Front view of Abdomen including both hips
B) 45 degree right and 45 degree left view
C) Right side and Left side view
 
Photo 1:
Photo 2:
Photo 3:
Photo 4:
Photo 5:
 
Back

needs :  

A) Front view of Abdomen including both hips
B) 45 degree right and 45 degree left view
 
Photo 1:
Photo 2:
Photo 3:
 
Underchin

needs :  

A) Front view
B) 45 degree right and 45 degree left view
C) Right side and Left side view
 
Photo 1:
Photo 2:
Photo 3:
Photo 4:
Photo 5:
 
Arms

needs :  

A) Front view of Both Arms in Flex90 degrees
B) 45 degree right and 45 degree left view
of Both Arms in Flex90 degrees
 
Photo 1:
Photo 2:
Photo 3:
Photo 4:
Photo 5:
 

Group V (Tummy Tuck or Abdominoplasty pictures) for Tummy tuck Surgery
Tummy Tuck or Abdominoplasty

needs   :

A) Front view of Abdomen including both hips
B) 45 degree right and 45 degree left view
C) Right side and Left side view
 

Right Side View

Frontal View Left Side View

Right Oblique view

Left Oblique view

Photo 1:
Photo 2:
Photo 3:
Photo 4:
Photo 5:
 

Group VI (Arm Lift or Brachioplasty Pictures) for Arm lift Surgery
Arm Lift

needs   :

Front view of Both Arms in Flex90 degrees
 

Right Arm
in 90 degrees Flexed Position

Left Arm
in 90 degrees Flexed Position

Photo 1:
Photo 2:
 

Group VII (Hair Transplantation Pictures) for Hair transplantation Surgery
Hair Transplantation

needs :

A) Front view of Face
B) Top view of Head
C) Back view of Head
D) Right side view
E ) Left Side View
 

Top Of Head

Frontal Hairline

Left Side View

Right Side View

Back of Head with Combing

Photo 1:
Photo 2:
Photo 3:
Photo 4:
Photo 5:
 

Group VIII (Miscellaneous)
Miscellaneous
Photo 1:
Photo 2:
Photo 3:
 
To discourage SPAM, we ask that you type your code (displayed below) in the text box.
Enter Validation Code :
 
 

Active member of societies