Istanbul Hair

Date

MonthDayYear
Patient number
Name
Surname
Email
Address
Zip | Place
Phone
DOB

MonthDayYear
Gender

MaleFemale
Treatment

Beard TreatmentEyebrow TreatmentUnshave Treatment (Advise by the speciallist)*FUE TechniquePRP Plasma TreatmentDressing DayShampoo and MedicalNumber of Crafts
Crafts
Number of Crafts
Travel schedule
Depart

AmsterdamEindhovenDusseldorfBrussels
Arrival Airport

Ataturk airportSabiha airport “ Asia side”
Arrival time

:AM/PM Option
Arrival date

MonthDayYear
Flight number:
Airline
Travel of people
Visa Check
paying in Istanbul
Hotel
confirmation number will be send
Checkin

MonthDayYear
AM/PM Option
Checkout

MonthDayYear
AM/PM Option
Pickup time

MonthDayYear
Hair treatmentAM/PM Option
Pickup time

MonthDayYear
Dressing dayAM/PM Option
Pickup time

MonthDayYear
Drop to the airportAM/PM Option

Medical Information For The Patient

	Yes	No
High Blood Pressure
Hemophilia
Chronic Deseases
Allergic Deseases
Allergies Against Drugs (medic)
Drink Regularly Alcohol
Do Smoke
Current Medicaments
Drug Consumption
Diabetes

Billing Invoice

	€ Euro
Crafts
PrP Plasma Treatment € 795,00
Shampoo and Medics € 95,00
2 Days stayover Hilton € 165,00
Fee Consultation € 49,00
Total xmas offer
Downpayment
Total payment in Istanbul

Restpayment
| 5 days before depart pleaseon Golden Palm Europe BV | NL 09 ABNA 0819153273
Subject: {name} {name99}
Customer Signature
Consultant Signature
Name
Name
Date

MonthDayYear
Date

MonthDayYear
GOLDEN PALM EUROPE BV | HOFPLEIN 20 | 3032 AC ROTTERDAM | THE NETHERLANDS
BANK: ABN AMRO | IBAN : NL 09 ABNA 0819153273
CHAMBER OF COMMERCE: 709 264 68 | TAX NUMBER : 8585.13.638.B01
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