The only information that MedicineOnline.com posts to the Bid For Surgery site is the information pertinent to your requested procedure. Your identity, contact information and credit card information will never be viewable by any other parties, including the bidding surgeons and dentists, until you decide exactly what you want each doctor to see about you.

Entering your personal information is safe. Our secure servers encrypt all data through Secure Socket layer (SSL) technology.

Request Bid For Breast Enlargement

Patient Information
  » indicates required field
First Name»
Last Name»
Gender
Date of Birth»
Address»

Address

City»
State/Province»
Zip/Postal Code»
Country»
DayPhone»
Night Phone»
Date of last physical examination
Do you enjoy good health now
Have you ever had a blood transfusion
If yes, please give approximate date:
Social History
Marital status
Alcohol Consumption
Your Occupation
Background comments
(Max. 8000 characters.) 
Medication History (List of medications you have used, or are currently using)
Please specify: Approximate date, name of medication, and amount
I have used or am currently using the following medications
(Max. 8000 characters.)

I am allergic to these medications
(Max. 8000 characters.)
Hospitalization History (List of hospitalizations, both inpatient and outpatient)
Please specify: Approximate date, name of physician, name of hospital or medical facility, reason for hospitalization (whether for medical or cosmetic procedure), and outcome
Hospitalization History
(Max. 8000 characters.)
Serious Illness / Injury History (List of serious illness/injury)
Please specify: Approximate date, type of serious illness or injury, and outcome
Serious Illnesses/Injuries
(Max. 8000 characters.)
Disease History
Cancer       High Blood Pressure       Kidney Disease       Tuberculosis      
General Health Information

Do you have a history of diabetes

Do you have high blood pressure

Do you have any heart problems

Cosmetic Surgery Specific Information

Have you had cosmetic /reconstructive surgery, If yes, please describe

Major concerns

Major fears

Family history of medical problems including reactions to surgery or anesthetics

My skin (select the appropriate response) »

I have/had skin cancer

I have/had cosmetic surgery, dermabrasion, skin peels, or laser treatments.

I have/had a herpes infection or cold sores on my face

I have been or now am under the care of a psychiatrist or psychologist

I have had a major life change in the past year

Has there been a recent death in family or recent divorce. If yes, please describe

Briefly describe your use of cosmetics »

Have you had cosmetic surgery, dermabrasion, skin peels, or laser treatment. If yes, please describe (including approximate dates)

What is your current height

what is your current weight

Age »

if you had a major life change in the past year please describe »

Specific Information
Patient Preferences
I am willing to travel for this procedure
You should expect to see bids from providers residing within your state.
In addition, some practices having nationally or internationally based clientele may also respond.
If you are not willing to travel for a service please ignore those that are too distant.


I want my procedure performed»
or doctor's choice
Brief description of your desired outcome of this procedure. (Max. 255 characters.)
For example,"Sleeker look from my tummy to my knees,"or "Bright smile that lights up a room."
This description will be your Bid For Surgery title, identiying your request to responding doctors.

Detailed description of your desired outcome of this procedure (Max. 8000 characters.)
Please include any additional information or concerns you'd want your doctor to know. For example, "I want to be back to work within three days," "I've always wanted this procedure but I'm not sure I can afford it,' or "I'am ready to go!' Remember, you're writing to doctor via a completely anonymous, private and secure system.

 Credit Card Information

We use your credit card information to verify your identity. Here's why.

Payment Method»
Credit Card Number»    No spaces or hyphens(-)
Expiration Date»
 User Name and Password
You will use your e-mail address as an account name for all your transactions plus a password that's specific to Bid For Surgery.

Please use a valid e-mail address where asked. Examples of e-mail addresses are john@aol.com and jane@earthlink.net. (all letters should be in lower case)

For good security, please choose a password that's different from the password you use to logon to your Internet Service Provider (in other words, use a password that's unique to this site). Choose something you'll remember, like beautifulme or bunnyslippers.(all letters should be in lower case)

Bid For Surgery will promptly give you an account number and send a confirmation letter and further instructions on activating your account, to the e-mail address you provide. Our system utilizes these steps to protect your privacy and positively identify you for future visits.

Email»
Password»

Verify Password»

» indicates required field

Yes, I agree to the terms and conditions of the above contract.
Date : 5/18/2013




Entering your personal information is safe. Our secure servers encrypt all data through Secure Socket Layer (SSL) technology.


Why do you need my credit card
Initially we use your credit card information to verify your identity and check that you are over 18 years of age, creating a safe and secure place to request a procedure.

After you have completed your registration and submitted your request for bids, you will receive notification that your request has been received by BFS Site. At this time you will be charged a $2 "Electronic Bid Fee" to post your request on BFS Site. This is a one-time charge.

Privacy Notice
We are very sensitive to the issues of electronic privacy. After all, we live in the virtual community, too. The information you have entered here will be encrypted and kept confidential. Our pledge is that we will not share your personal data with anyone else - period. If others want this information, you must give it to them.


Copyright © 1995-2006 Medicine Online Inc. medicine online & mol.net All rights reserved. Medicine Online and MOl are Registerd Trademark of Medicine Online Inc. Patent Pending. No part of the contents of this Website may be reproduced or transmitted in any form or by any means, without the written permission of the publisher."medicine Online .com" should be prominently displayed on any material reproduced with the publisher's consent.