Contact ProCosmediq | Niki Cirillo

First name

Last name

Email

Phone

Which ProCosmediq service are you enquiring about?

Medical Tattoos

Areola Repigmentation

Belly Button Tattoo

Other

Are you interested in making an appointment?

Yes

Other (please complete the section below with more details about what you are enquiring about)

Other (additional information)

When would you prefer a phone call to organise your appointment?

Within 24 hours (urgent)

Within 7 days

When was your last surgery, chemotherapy or radiation treatment?

More than 2 years (no medical clearance is required)

Less than 2 years (a medical clearance letter is required and must be emailed to niki@procosmediq.com.au at least 2 weeks prior to your appointment). You may obtain this letter from your GP, Surgeon or Oncologist

n/a

Medical Clearance Letter (if you already have a copy)

Please advise who your referring surgeon is (if you were not referred directly by one of my referring surgeons, please still provide the name of your surgeon)

Please select your surgeon’s location

Cronulla (all other surgeons)

Wollongong (Dr Starr, Dr Palasovski, Dr Beck)

Chris O'Brien Lifehouse (Dr Dusseldorp)

I have read & understood the Price & FAQs relevant to the service that I am wanting to make an appointment for (see links below):

Yes

No

n/a

Additional Information

I declare that I am over 18 years of age and that the information that I have provided is accurate & true

Online Enquiry Form