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Start a Non-Clinical Enquiry
  • Services & Treatment
    • Dental Treatments
    • Plastic & Reconstructive Surgery in Bali
    • Dermatology & Non-Surgical Cosmetic Care
    • Women’s Health
    • Wellness & Preventative Health
    • Other Healthcare Services
  • Participating Providers
    • RS InMedika
    • GiO Dental
    • The Solitaire
    • Uluwatu Dental
    • NgoerahSun WAC
    • Cocoon Medical Spa
    • Mesari Beauty Studio
    • Bali Luxe
    • BIMC Siloam
    • NuLook
  • How It Works
  • Start An Enquiry
  • About TJC
  • Provider Credentials
  • Knowledge Centre
  • Services & Treatment
    • Dental Treatments
    • Plastic & Reconstructive Surgery in Bali
    • Dermatology & Non-Surgical Cosmetic Care
    • Women’s Health
    • Wellness & Preventative Health
    • Other Healthcare Services
  • Participating Providers
    • RS InMedika
    • GiO Dental
    • The Solitaire
    • Uluwatu Dental
    • NgoerahSun WAC
    • Cocoon Medical Spa
    • Mesari Beauty Studio
    • Bali Luxe
    • BIMC Siloam
    • NuLook
  • How It Works
  • Start An Enquiry
  • About TJC
  • Provider Credentials
  • Knowledge Centre

Step 1 of 7

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PLASTIC & RECONSTRUCTIVE SURGERY
ENQUIRY FORM

InMedika Hospital Bali — International Surgical Services
Medical Tourism Program   |   International Patients Welcome
ℹ Please complete all sections marked * before submission. This form enables our surgical team to prepare your telemedicine consultation. All information is treated as strictly confidential.

1. PERSONAL DETAILS

Name(Required)
Gender(Required)
Country of residence(Required)
Australian state / city

2. REFERRAL SOURCE

3. TREATMENT YOU ARE SEEKING

What Treatment You're Seeking Of:(Required)
Do you have recent photos, medical reports or previous surgical notes to share?(Required)
Max. file size: 512 MB.

4. BUDGET (OPTIONAL)

Budget:
Your budget is completely optional to disclose. Sharing it helps our team prepare a treatment plan that aligns with your goals and financial expectations.

5. TRAVEL & STAY

Assistance in Bali — please tick all that apply:(Required)

6. HEALTH & MEDICAL

Smoking / vaping / nicotine(Required)
Pregnant or breastfeeding?(Required)
Previous adverse anaesthetic or surgical reaction?(Required)
Level of surgery anxiety(Required)

7. CONSENT & DECLARATION

Consent(Required)
Consent(Required)
Consent(Required)
Consent(Required)
Signature
  • Your Name
  • Your Name
  • Your Name

YOUR PATIENT JOURNEY — INQUIRY TO AFTERCARE

What happens after you submit this form

1

Inquiry received

Your form is reviewed within 1 business day and the next step for surgical review is confirmed.

2

Telemedicine consultation

A video consultation is scheduled at a suitable time. Photos, medical details and goals are reviewed.

Preliminary only; in-person assessment is required.
3

Treatment pathway & estimate issued

You may receive a proposed pathway, cost estimate in IDR/AUD and appointment or surgery dates.

Indicative until in-person assessment.
4

Billing terms & deposit

Any required deposit, cancellation terms and inclusions are stated in your written estimate.

5

Arrival, hospital meet and greet

Your PIC assists with registration and guides you to consultation or admissions.

6

In-person assessment & pre-operative checks

Your treating team confirms suitability, explains risks, obtains consent and arranges required pre-operative tests.

7

Surgery, recovery & payment

Your procedure is performed by the treating team. Payment follows the written estimate and hospital terms.

8

Post-operative care & follow-up

You receive aftercare instructions, follow-up details and emergency contact information.

WhatsApp aftercare support where included.

A Community Built on Shared Experience

TJC Group’s success has been driven by the willingness of patients to support one another through shared knowledge and lived experience.

Every story contributes to a growing body of information that helps future patients navigate complex healthcare decisions with greater confidence and understanding.

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 Important Disclaimer

TJC Group Medical and Dental Pty Ltd provides general healthcare information, non-clinical administrative support and introductions to independent healthcare providers. TJC does not provide healthcare, diagnosis, clinical assessment, treatment recommendations or emergency assistance. All clinical decisions, treatment, pricing, informed consent and aftercare remain matters between the individual and the treating healthcare provider.
Commercial Disclosure
TJC has commercial relationships with some participating healthcare providers and may receive remuneration from those providers. Individuals are not required to use a provider introduced by TJC. Commercial arrangements do not give TJC authority over clinical decisions, treatment recommendations, pricing or patient care.

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