• Home
• About Us
  • Dr. Craig Layt
  • The Practice
  • The Team
• Procedures
  • Breast Augmentation
  • Breast Reduction
  • Breast Lift
  • Breast Reconstruction
  • Tummy Tuck
  • Liposuction
  • Eyelid Surgery
  • Brow Lift
  • Face Lift
  • Nose Reshaping
  • Ear Reshaping
  • Gynaecomastia
  • Labioplasty
• Non Surgical Options
  • IPL
  • Cosmetic Injections
  • Microdermabrasion
  • Chemical Peel
  • Skin Care Therapy
  • Laser Skin Resurfacing
  • Face Lift Non-Surgical - Thermage
• Skin Care Products
  • Sunscreen
  • Cosmetics
  • Skin Care Products
• Privacy Policy
• Contact Us
• Request a Consultation
• News

To view this, you need to install the Flash Player 7. Please go to here and download it.

Contact Us

Dr Craig Layt also consults at:

Ballina Clinic
Ballina Health Centre
32 Tamar Street
Ballina, NSW, 2478

Benowa Clinic
Suite 1, AHC House
14 Carrara Street
Benowa QLD 4215

* indicates a required field
Where would you prefer to have your consultation:? Choose one... Gold Coast Ballina

Patient Information

*First Name:
*Surname (Last Name):
* Address:
*Suburb:
* Postcode:
* Email Address:
Date of Birth:
Marital Status:
* Phone:
Work Phone:
Mobile Phone:
Height:
Weight:
DVA Membership No. (if applicable):
Private Health Fund Company:
Membership No:
Medicare No:
Number next to your name:
Expiry (__/__):
How did you hear about our us? Choose one... ----------------------- GP Specialist Yellow Pages Radio Friend Gold Coast Magazine Other
If other please state:
Tick here if you do not wish to receive special Promotions and Newsletters.

Who is your GP?
IMPORTANT! Are there any medicines you have an allergy to?:

Please tick if you have had any problem with?

Diabetes
Asthma/Breathing difficulties
Epilepsy
Blood pressure
Bleeding tendency

Blood Clots
Heart disorder
Arthritis
Liver/Kidney Disease
Infectious Diseases eg. Hepatitis/HIV

Any other we need to know about?
Have you had any operations in the past?

Yes No

Please List:
Do you have a family history of any illnesses?

Yes No

Do you take aspirin or arthritis tablets?

Yes No

Please list any other medicines you take. Have you had any problems with anaesthetics?

Yes No

Do you smoke?

Yes No

If yes, how many a day? Gender Choose one... Male Female

Ladies

How many children do you have?
How many caesarian sections did you have? Do you plan to have any more children?

Yes No

Could you be pregnant?

Yes No

I would like a consultation on: Choose one... ----------------------- Breast Enlargement Breast Lift Breast Reduction Breast Reconstruction Breast Nipple Correction Tummy Tuck Liposuction Facial Surgery Nose Surgery Ear Reshaping/Correction Other

Comments:

Canberra Article Coast Article Label Article Label Article Label Article Label Article Cosmedix AST Payment Options

back to top

• Home
• The Surgeon
• The Practice
• The Team
• Breast Augmentation
• Breast Reduction
• Breast Lift
• Breast Reconstruction
• Tummy Tuck
  
• Liposuction
• Eyelid Surgery
• Brow Lift
• Face Lift
• Nose Reshaping
• Ear Reshaping
• IPL
• Cosmetic Injections
• Microdermabrasion
• Chemical Peel
  
• Skin Care Therapy
• Laser Skin Resurfacing
• Face Lift Non-Surgical - Thermage
• Sunscreen
• Cosmetics
• Skin Care Products
• News
  
• Request a Consultation
• Contact us
• Site Map
• Privacy Policy

Dr. Craig Layt and his team of experienced professionals are dedicated to superior cosmetic surgery results. The privacy, safety, and satisfaction of our patients are our highest priorities. We offer a range of services to suit the needs of all of our patients.

Dr. Layt is associated with the DocShop network. DocShop provides patient education information about common cosmetic surgery procedures.

Benowa Clinic - Suite 1, AHC House, 14 Carrara Street, Benowa QLD 4215
Ballina Clinic - Ballina Health Centre, 32 Tamar Street, Ballina, NSW, 2478
Phone: (07) 5597 4100 or (13) 0066 7763

Copyright © 2007 Craig Layt | Website Developed by Einstein Medical