Recovery Suites Form - Body by Yashi

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Your Information - Step 1 of 6

PLEASE BE READY TO MAKE YOUR DEPOSIT AT THE COMPLETION OF THIS FORM. MAKING A DEPOSIT IS THE ONLY WAY TO RESERVE YOUR SPOT.

Name *

First

Last

Date of Birth *

Gender *

Select an option

Email *

Phone Number *

Select a package *

King Suite
Surgery Sister Suite

All Inclusive (5 Nights/6 Days)

Check-in date: *

MUST check-in at least one day prior to surgery (pre-op)

Check-out date: *

How many SURGERY patients will be recovering in this suite? *

Select an option

If you're booking with your surgery sister, please list their name.

All surgery patients booking with Recovery Suites must complete their own form

Do you have any allergies? *

List all allergies *

Are you taking any medication(s) or vitamin(s)? *

List all medication(s) or vitamins(s) *

Do you have any pre-existing health issues/diseases? If yes, please explain *

Name of surgeon *

Date of procedure *

Type of procedure(s) *

Liposuction
BBL (Fat Transfer)
Tummy Tuck
Breast Augmentation
Breast Lift
Other

Select all that apply

List food preferences & food allergies *

To help us serve you better, please list any additional information.

A $200.00 non-refundable deposit is required to book. Deposit goes toward balance. Balances must be paid in full 2 weeks prior to your arrival date. ALL SALES ARE FINAL: There are no refunds or exchanges on any products or services. *

Type Full Name

Signature

Booking Deposit *

Price: $ 200.00

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