Client Questionnaire

What happens
after you submit



Dr. Zuzana Cerna
Chief Surgeon


Your information will only be viewed by Laderma chief surgeon Dr. Cerna and patient coordinator Katka Formankova.



Katka Formankova
Patient Coordinator


We will let you know in two business days about our opinion on your procedure and about open operation date.

This questionnaire has been designed to make the initial communication between our clients
and the Clinic easier and more accurate.

Please fill out all information marked with *.

Thank you very much for your co-operation.

*:
*:
male   female
*please enter phone and e-mail, we will contact you
on the phone only in case of emergency
Please attach a photo of the part of your body
you intend to have an operation on,
or write a link for us to view it.
Breast Enlargement
en
Breast Reduction