Beautiful Escapes - Beautiful Escapes NZ

Call us today on 0800 472 469 or simply fill out the quick and easy booking form below.

Full Name *

Passport Number *

Frequent Flyer Number: (e.g.Airpoints number)

I understand that the payment of NZ$450 is for the booking confirmation and is non refundable *

I understand that I pay the cost of my procedure to the Hospital after my initial consultation with my surgeon. *

Preferred Payment Method

I elect to pay my booking confirmation of NZ$450 by *

	Cash
	Credit card ( we will call you )
	Internet transfer ( we will email you our account number)

Person(s) Accompanying You:
(Name as in Passport)

First Name 1

Last Name 1

First Name 2

Last Name 2

First Name 3

Last Name 3

Disclaimer:
Please read the disclaimer carefully because it is an essential contractual condition of all bookings accepted by Beautiful Escapes.

I have read, acknowledged and fully understand the attached disclaimer and accept it. *

On receipt of this Booking, Beautiful Escapes will respond with hospital registration and other necessary documents.

Please enter the verification code in the image above *