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Passport Name *

Gender *

Date of birth(dd/mm/yy) *
Email *
Cell phone *
SNS Account *

Surgery History *

Please include Surgical History and Allergy (be as specific as possible). *
Date of Surgery(dd/mm/yy) *

Promotion Info

TS Plastic Surgery
First Rhinoplasty
¥15,946 ¥43,590

Final Settlement Info

Price
43,590
Discout price
27,644
VATPrice
0 USD

The amount due
15,946