For a Seriously Better You....

  English | Indonesia |

Appointments

021 727 838 27

Out of Hours
Emergencies

0813 2270 1326

 

Click the link below to find out what your BMI is and what that means

Registration / Signup

This registration provides you with a member account to Skinny World HCG Weight Loss Program services. Please note that fields marked * are required.

Weight Loss assisted by HCG has little to no side effects on most patients, however, it is a requirement that you read and agree to the disclaimer information prior to registration. Click here.


Patient First Name
Patient Last Name
Occupation
Male
Female
Date of Birth
Highest Weight
Current Weight
Height
Address
Suburb
Zip Code
City
Country
Daytime Telephone -   example +62-123456789
Mobile Phone
Email
Facebook Account
Please complete the following information about your health status and medical history:
Health History
Diabetes
   Type 1
   Type 2
   Gestational
Heart Disease
   Valve replacement
   Heart Attack
High Blood Pressure
Kidney Disease
   Kidney Stones
Cancer
   Type
Stroke
   Impairment
   No impairment
Thyroid Dysfunction
Menstrual Disorders
Constipation
Breathless on Exertion
Asthma
Seizure Disorder (epilepsy)
Migraine or Headaches
Rheumatic Pains
Medication
I have read the Disclaimer Information and give Informed Consent to proceed with Skinny World HCG Weight Loss Program.
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Head Office

Jl. Wijaya IX no 4

Kebayoran Baru - 12160, Jakarta Selatan

Phone    : (62 21) 727 83827

Email     : bodyclinic@indo.net.id

Contact  : Practice Manager