4 Burke Road, Malvern East, 3145 Victoria
PH: +61 3 9569 3511
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Treatments

Non-Surgical
Surgical
Online Liposuction Consultation
This allows you to obtain a cost estimate on your liposuction treatment.

We will need to see you in person to give you an accurate estimate on other procedures as there are too many variables for us to evaluate these properly on line. From an ethical perspective we would rather give you a properly assessed price.

The required photographs are vital for us to be able to make a proper assessment of your treatment. It is important that these are taken as per our requirements.

Please fill in the fields below.

Alternatively, you may send the information directly to the clinic by simply printing the form and faxing it to (03) 9569 3522.

Personal Details
Full Name
Gender
Age (years)
Postal Address
Email Address
Phone Number
How would you like to be contacted?
Height (cm)
Weight (kg)
Existing health conditions
Medications you are currently taking
Which procedure(s) are you considering? How may we help you?

Photos
To attach a file click on the "Browse..." button and select the image you would like to send (which should already be stored on your computer).

How to take correct photos:
  • Take poses as shown below
  • Use flash to make shots are sufficiently light
  • Wear minimal underwear so that we can see the area to be treated.
  • The sent files need to be JPG files with each shot less than 100KB.

For Hips, stomach, buttocks and upper thighs:
 
Photo #1
Photo #2
Photo #3
Photo #4

Neck and chin:
 
Photo #1
Photo #2
Photo #3
Photo #4
 

General information (optional)
Do you find the before and after photos helpful on this website?
Do you have any comments you wish to make on our web site?
* Please enter verification word shown to submit your form.
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  The Ashley Centre
4 Burke Road
Malvern East
Victoria 3145 Australia
Tel (+61 3) 9569 3511		  
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