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Thank you for visiting our web site softesthetique.com. To enable us to respond to you clearly and accurately and as quickly as possible, we recommend that you carefully fill in all fields of this form and send us photos (attach at the bottom of the form) of the parts of your body to be treated. These photos are absolutely essential to allow the surgeon to make a first accurate diagnosis.

Important : Fill in this form does not in any way commit you and all information contained therein remain fully confidential.
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first name *
   
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Phone
   
Age
   
State of health
Current treatment
   
Your request
   
Type of intervention *
   
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(Extensions accepted :
jpg, jpeg, png et gif)



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