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Hospital Clinica Biblica Service Estimate Request

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Patient Details
Have you previously been a patient at Hospital Clinica Biblica? No
Patient Registry Number:

• Patient Name (please provide name as it appears on passport):
          First Name: *

          Last Name: *
• Date of Birth: *
• Gender: * Female     Male
• City: *
• Province / State:*
• Country: *
• Phone Number:* [ i.e. 506-522-1000 ]
• Fax Number: [ i.e. 506-221-0645 ]
• Email Address:*
• Interpreter Requirement:: Encouraged if your primary language is not english or spanish.
Interpreter needed? No
Yes                   Language:

Medical Condition Details
• Appointment Type Requested: *

Please click each category to view the procedures and choose the ones that you require:

+ Cosmetic Plastic Surgery

  Facial Plastic Surgery

Face Lift
Eyebrow Lift / Forehead Lift
Rhinoplasty (Nose Surgery)
Chin Implant
Cheek Implants (Malar)
Aptos Threads

Breast Surgery

Breast Enlargement
Breast Reduction
Breast Lift

Leg Surgery

Calf Implants
Gluteal Implants


Hair Treatments

Hair Replacement
Hair Removal



+ Bariatric Surgery

  Laparoscopic Adjustable Gastric Band (Lap Band)
Laparoscopic Roux-en-Y Gastric Bypass (Stomach Stapling)
Biliopancreatic Deviation
Intragastric Balloon

+ Orthopedic Surgery


Hip Replacement

Extremity Arms

Shoulder Arthroscopy
Carpal Tunnel Syndrome

    Extremity Legs

Toe Deformity
Knee Replacement
Knee Cruciate Ligament Repair
Knee Arthroscopy

+ Dentistry

  Restorative Dentistry

Dental Bridge
Dental Veneers
Partial Prosthesis

    Cosmetic Dentistry

Dental Bleaching
Dental Cleaning

+ Ophtalmology

Macular Disease
    Retinal Detachment

+ Medical Tests (Check Ups)

  Older Adult (45 or over)

Executive Plan A (45+)
Comprehensive Executive Plan B(45+)

Adults (35 to 45 years old)

Executive Plan (35-45)

Young Adults (under 35)

Basic Plan (-35)


Gynecological Plans


Children Plan

+ Dermatology


Cosmetic Fillers
Chemical Peel



• Please detail your current Diagnosis and/or Symptoms:
(Please be as specific as possible)
• Appointment date requested: *

Terms of Use
I have read and understood Hospital Clínica Biblica's Terms of Use.

Payment Options
Every client must make a previous deposit for the services at Clínica Bíblica hospital. When you Request information, our representatives will inform you of the steps you should follow.

Clínica Bíblica Hospital accepts main credit cards, including: MasterCard, Visa and AmericanExpress.

International Department 
Our international department will answer all your questions on payment, as well as unpaid bills. You can contact us through different means:

Phone: (506) 522-1500
Mailing address: International Department Asociaci�n de Servicios M�dicos Costarricenses
J.B.C. SJO #1138, P.O. Box 025240
Miami, Florida 33102-5240, USA
Fax: (506) 257-7307
Contact Form

Code of Ethics
Clínica Bíblica Hospital, its doctors, nurses and employees follow a Code of Ethics which has been the base for our international recognition. Our Code of Ethics.

Better Your Health Starting Today
• Receive health tips and special promos.

•  Read health articles from past editions.

Organize Your Trip to Costa Rica
Things to do
Learn about the advantages that Hospital Clinica Biblicas' location offers so you can enjoy your visit to Costa Rica.

Where to Stay
There are many options nearby the Hospital which will also permit you to discover Costa Rica.

Insurance Coverage Options
Learn about the financing options we offer to foreign patients.


Cosmetic Plastic Surgery . Weight Loss Surgery . Orthopedic Surgery
Dentistry . Eye Surgery . Medical Tests (Annual Checkup)

Copyright � 2007 Hospital Cl�nica B�blica
1st & 2nd Street, 14th & 16th Avenue
POBox 1307-1000 San Jos�, Costa Rica . Tel.: (506) 522-1000 . Fax: (506) 221-0645

Information on this web site is provided for informational purposes only and is not intended as a substitute for the advice provided by your physician or other healthcare professional. You should not use the information on this web site for diagnosing or treating a health problem or disease, or prescribing any medication or other treatment.