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Section 1: Personal Information

Full Name

Date of Birth

Email

Phone number

Current Residence Country

Preferred Language

Section 2: Procedure Information

Have you already selected a clinic?YesNo, I need help finding one

If Yes:

Clinic Name

Clinic Contact Person (if known)

Clinic Location (City, Country)

If No: HYKR can connect you with trusted and verified clinics

Section 3: Treatment Details

Type of Procedure and Waiting Period

Dental (Tier 1,2,3)

Waiting Period

Dental Procedures
Veneers, Crowns, Bridges
Wait Time: 10 days
Tier: All tiers

Dental Implants
Wait Time: 90 days
Tier: All tiers
Why: Implant fusion with bone takes 8 to 12 weeks, and issues like rejection or mobility cannot be confirmed sooner.

Hair Transplant (Tier 3)

Waiting Period

Wait Time: 12 months
Tier: Tier 3
Fee: 15%

Rhinoplasty (Tier 3)

Waiting Period

Wait Time: 12 months
Tier: Tier 3
Fee: 15%

Cosmetic Surgery (Tier 1,2,3)

Waiting Period

Liposuction
Wait Time: 90 days
Tier: Any tier

Tummy Tuck
Wait Time: 90 days
Tier: Any tier

Other Cosmetic Procedures
(BBL, breast lift, arm lift, thigh lift, chin lipo, etc.)
Wait Time: 30 days
Tier: Any tier

Non-Surgical Procedures

Waiting Period

(Botox, filler, PRP)
Wait Time: 10 days
Tier: Any tier

Brief Description of Treatment Desired

Coverage Limit (Check your Tier)

Tier 1: $3,000Tier 2: $5,000Tier 3: $10,000

Section 5: Verification Documents (Upload)

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Section 6: Consent and Acknowledgment

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