forms

enquiry form

medical questionnaire

booking form

medical questionnaire - Dental Surgery

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FORMS

Enquiry

If you are interested in finding out more about the service that we can offer you, please complete and submit the Enquiry form.

You will then receive a cost estimate for the procedures you are interested in, information on the procedures, the recuperation period required for these procedures, information on your accommodation and recuperation and holiday options.

Medical questionnaire

Please complete this form in order for our surgeons to formulate an idea of your medical history and hence your suitability for surgery.

Here you can address all questions you may have regarding your surgery and the surgeon can answer these for you. E mail questions are the easiest form of fast communication and we encourage all of our clients to take advantage of this communication.

Please mail all questions to us and we will forward them to the surgeon. Once a reply is received we will promptly forward these back to you.

Comprehensive quotations

Once you have submitted your pre operative questionnaire we will compile a comprehensive quotation for you.

Booking

Once you are comfortable with your choice you can make a provisional booking with us to secure the dates you are interested in.

When you have made your final decision, please complete the booking form and submit it with your deposit amount, signed terms and conditions and flight details.

The balance of your payment is then due 14 days prior to your departure date.

Terms and Conditions

Please make sure that you have read and understood the terms and conditions.

EVOLUTION COSMETIC: TERMS AND CONDITIONS OF BUSINESS

1. For ease of reference, the following meanings are ascribed to the following terms
"EVO" means EVOLUTION COSMETIC;
"The Client" means the individual or his/her representative who intends to agree or who agrees to the package and the procedure, agreement to the procedure being signified by his/her signature of EVO's booking form/consent form, or of the consent form provided by the surgeon; 
"The procedure" means the relevant cosmetic surgery or alternative medical procedure stipulated in EVO's booking form or consent form, or in the consent form provided by the surgeon, and "surgery" shall have a corresponding meaning. In the event of any discrepancy between the procedure stipulated in EVO's booking form and that stipulated in the surgeon's consent form, the latter shall take precedence;
"The package" means the total package elected by the Client, which shall include airfare, hotel or alternative accommodation, hospital-and after-care, and the procedure;
"The surgeon" means the medical practitioner elected by EVO to conduct the relevant surgery. The surgeon is an independent practitioner, and shall at no time be deemed to be an agent or representative of EVO

2. APPLICATION
These terms and conditions shall apply to any agreement between EVO and the Client, whether that contract arises out of any request or booking made by the Client and accepted by EVO, or any offer made by EVO (including a quotation) and accepted by the Client;
Any agreement between the parties shall be governed by and subject to the laws of the Republic of South Africa, and the appropriate court of South Africa shall be vested with jurisdiction over that dispute.

3. PAYMENT
Upon receipt of a request for a package and one or more procedure, EVO shall provide the Client with a quotation stipulating the total estimated cost of the package and the procedure, and the amount of the deposit payable. The quotation shall be an estimate only, and may be subject to variation arising, inter alia, from fluctuations in exchange rate as well as the cost of airfare, hotel and accommodation; 
The Client shall signify its acceptance of the quoted price, and of these terms and conditions of business, by signing the booking form;
Upon signature and submission of the booking form, the Client shall be obliged to effect payment to EVO of a deposit, which amount shall be calculated by EVO at its sole discretion. The said amount is non-refundable, notwithstanding the termination or cancellation of the agreement between the parties, and irrespective of the reasons for such termination or cancellation. EVO shall not be obliged to arrange the elected package until such time as the deposit has been paid in full;
The booking form and deposit shall be submitted by the Client to EVO no later than 28 (twenty eight) calendar days prior to the intended date of departure;
Upon receipt of the booking form and deposit, EVO shall arrange the selected accommodation and the procedure/s. The Client shall be responsible for flight and travelling arrangements, as well as the cost thereof. EVO shall assist the Client to make the neccessary travelling arrangements, should the Client's request such assistance; 
Subject to this clause 3. the Client shall be liable to effect payment of the total amount stipulated in the booking form. The balance payable by the Client (namely, the total stipulated cost less the paid deposit) shall be paid in full by the Client by no later than 7 (seven) calender days prior to the date of intended departure to the Republic of South Africa;
In the event that the elected package or procedure is altered after the submission of the booking form, EVO shall recalculate the total cost payable, and the Client shall effect payment of the amended total cost, immediately upon request by EVO, and prior to surgery. In the event that the total cost is less than that originally stipulated, EVO shall refund the difference between the original amount and the new amount, less the amount of the original deposit and the amount of any disbursements incurred by EVO to the last (or only, whichever is applicable) date of surgery; 
EVO reserves the right to alter the total amount payable in the event of increases in the airfare, hotel and/or accommodation costs, and costs of surgery, hospital and aftercare charges, or any other disbursement encompassed in the elected package. The altered amount shall not exceed the actual amount by which these costs have increased. Any additional amount that is payable by the Client in terms hereof shall be paid to EVO immediately upon request;
Any amount not paid by the Client on the due date shall bear interest at the maximum rate permissable in the Republic of South Africa, from time to time, as set forth in the Limitations Disclosure of Finance Charges Act.73 of 1968, as amended, or any other applicable legislation; 
The applicable currency exchange rate is: in respect of the deposit, the rate ruling on the date upon which the booking form is submitted; and in respect of the balance, the rate ruling on the date of payable and the date on which they are paid, shall be borne by the Client in full;
All amounts quoted or agreed are exclusive of any applicable taxes, including VAT. 
Payment shall be effected either in South African currency or in Pounds Sterling, at EVO's sole discretion, and shall be payable in a manner prescribed by EVO. Payment by direct deposit shall not be construed until such time as clearance has been obtained. Payment by negotable instrument shall not be construed until such time as such negotiable instrument has been met on presentation.

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