Forms

Cost estimate form

We would like to thank you for having visited cosmetica Travel website. In order to allow us to answer your queries clearly and thoroughly and in the least possible time, we would like to advise you to fill in all the boxes of the present form.
1-Othopedic procedures: please be preapared to supply x-rays and doctor's reports
2-Other procedures: please be prepared to supply the necessery reports such as doctor's
reports or blood test reports,...


Surname * :
Forename * :
Date of birth * :
Profession :
Adress :
City :
Post code/ Zip code :
Country :
Nearest airoport :
Home phone :
Work phone :
Mobile phone :
If you accept to be contacted by one of our team members preferred contact time :			Monday to Friday at 8h30 to 16h30
Fax :
E-mail * :
Procedure
Option :
Other :
Hotel :
Arrangement :
Type of room :
Number of adults :
Number of children (6 to 12) :
Number of children (less 6) :
When will you consider travelling to Tunisia ? :
Excursion/Leisure (not included in the package) :
Comments :
*Fields marked with an asterisk are required.**

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Cosmetica Travel

Brand of medical tourism managed by SIROKO TRAVEL
Leading specialist in medical and cosmetic surgery tourism to Tunisia.
Limited company (LTD) with a capital of 107 000 Tunisian Dinars – Constituted in 2004
Commerce registration N° « B 241802 2004 »
Fully bonded travel agency, holder of a category “A” licence n°1515, granted by the Tunisian National Tourist Office
Member of the Tunisian Federation of the Travel Agencies : N° S 39
Holder of the Professional and civil responsibility insurance N° 027100076 /0 - Insurer "COMAR"