Medical Questionnaire

We are happy to give you a price quote and additional information about your proposed procedure including how many days you will need for post-op recovery before returning home. Please give us some basic information about your medical history along with the procedure(s) you have in mind, and we will promptly reply with further details.

Generally, it is not necessary to send us photos. We respect your privacy and understand the inconvenience of sending sensitive photos by email. You may, of course, do so if you wish to advise us of specific conditions or to more accurately quote a price price. Please send any photos as an email attachment to

Upon receiving this Medical Questionnaire, Dr. Araya will determine the scope of your requested surgery and send an estimate through our patient coordinator. You may rely on the estimate to be accurate and factual. Later adjustments to the quote can always be made by mutual agreement with Dr. Araya during your pre-op examination, but the price quoted by email will always be our correct price for the standard procedure.

You may have your pre-op consultation the same day of arrival if you arrive early enough in the day. Otherwise, you can relax for the evening at the Costa Rica Medical Center Inn and see us the next day. Initial consultations are generally in the late afternoon. Your surgery will usually be performed the next day.

You will need a medical checkup prior to your procedure and you may have it done either at home, or here at our hospital. We have complete facilities to do all required medical tests quickly and at a nominal cost at the time of your pre-op consultation.

Please complete the following and submit to us:
First Name: *
Last name: *
Email: *
Sex: Male Female
Age: years
What type of cosmetic surgery interests you?:
Abdomen Ears
Arms Eyelids
Breast Augmentation Face
Breast Reduction Neck
Buttocks Nose
Chin Thighs
Please list any previous surgeries with dates:
How is your general health?: Excellent Good Fair Poor
Do you have any particular health problems? If yes, please explain:
Any allergies? ( please specify ):
Any negative experience with anesthesia?. If so, please explain:
Medicines you take at present:
Do you use tobacco?
Please list below any specific comments or questions you may have:
Please give us a preferred date and a secondary date, if possible, for your procedure:
Preferred date:
Secondary date:
Thank you. We will promptly replay with answers to any questions you may have. A general overview of your requested surgery, a price quote, and availability of your requested dates will also be sent.
The * denotes mandatory field
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