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“Venus Services is dedicated to providing excellent and customized customer service to every client. Accordingly, we treat the information provided to us as confidential and proprietary. And we guarantee the respect of our patients’ private life. Your data will only be transmitted to your doctor and to your Venus Esthetique consultant for a medical purpose and for delivering to you a customized service.”

Private data
N.B: The stars * in the form indicate the compulsory data.

Marital status :
First name* :
Last name* :
Date of birth*:
(dd/mm/yyyy)
//
Nationality* :
Profession:
E-mail adress* :
Password * :
Phone:
Mobile:
Postal address* :
City* :
Postal code* :
Country* :
Please choose your category of operations :
Aesthetic surgery & medicine info
Obesity surgery info
Hair graft info
Dental surgery info
N.B: To choose procedures in multiple categories, please, click at “new consultation” in your private space. Your demands will be treated separately and faster. You would not have to answer twice data you have already provided.
Please, choose your procedure(s):
1st treatment choice :
2nd treatment choice :
Other treatment ?
How did you hear about us?*
(Website, forum, press,etc...)
How may we contact you? *
Your ID :
Click here , if you would rather prefer to download the paper version then send it back to us once completed to the following address:
Vénus Services, Tanit Médical, 2ème étage, Avenue du Japon, Montplaisir 1073 Tunis.
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Tanit Medical, 2ème etage Avenue du Japan, Monplaisir 1073 Tunis     Tél: +216 70 860 590     Fax: +216 70 860 590
Copyright Venus esthetique 2008
Conception & Réalisation eDirect Tunisie