If you would like guidance regarding your case, we would request you to complete this form.

» YOUR COUNTRY

If circumstances permit, you may be offered a pre-operative consultation closely followed by a date for surgery so that you would only have to make a single trip if you live far away
» BACKGROUND INFORMATION

Bearing in mind that the reconstruction is usually performed after 9 or 10 years of age


» YOUR PERSONAL DETAILS
» YOUR PHOTOS

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