ALIA Clinic cosmetic surgery and Cosmetic medicine NSW Australia

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For Appointments :	(02) 99061555
	1300 556 615

appointments

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Wrinkle Reduction Only

In which areas of your face are you interested in reducing wrinkles? *

	Between the eyes ( 1 area )		Crows feet by the side of the eyes ( 1 area)
	Between the eyes and Crows feet ( 2 areas )		Forehead (1 area)
	Between the eyes, Crows feet and forehead ( 3 areas)		Other...

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Please give me information on the approximate costing of the procedure.

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If you have any problems in the transmission of this form, please forward a separate email to aliaclinic@gmail.com

For more information about choosing a doctor or deciding on a cosmetic procedure, please download a copy of the Australasian College of Cosmetic Surgery’s patient information brochure, "Things you should know". A copy of the ACCS Code of practice is also available by visiting the College’s website.