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Virtual Consultation Form

VIRTUAL CONSULTATION

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All information submitted is strictly confidential and protected by HIPAA compliance

Before we start...

All information submitted is strictly confidential and protected by HIPAA compliance
What’s your first name ?
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Really nice to meet you, Sarah !
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VIRTUAL CONSULTATION

First, let’s talk about your goals.

Tell us about your goals. Your patient care concierge will create a personalized surgical plan to achieve your dream body.

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Goals

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What type of procedure(s) are your interested in ?
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Goals

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Choose your specific procedure(s)
BREAST PROCEDURE
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FACE PROCEDURE
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BODY PROCEDURE
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Goals

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Non-surgical procedure
What procedures are your interested in ?
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Goals

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What are your concerns? What are your goals?
See an example
VIRTUAL CONSULTATION

Share your goals.

Example:

I am a mother of three with excess skin around my tummy after childbirth. Despite being super active, it feels like no matter what I do that extra skin just won't go away. I am looking to tighten and tone my abdominal area to get my pre-baby stomach back. I have also noticed my breasts drastically decrease in size and perkiness after breastfeeding. I am hoping Dr. Barrett can recommend the best procedure to give me some lift and volume back.

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Now, let’s cover the basics.

We’re working on your plan! Give us some basic background information so we can keep curating your journey.

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Basics

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What’s your height  and weight ?
|  ft
|  in
|  lbs
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Basics

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How many pregnancies have you had, if any?
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Basics

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Have you had past surgical procedures?
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We are almost there!
Time for photos.

Follow the photo guide to upload pictures of the area(s) of focus. Your surgeon will review these before your in-office consultation.

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Photos

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*UPLOAD 3 PICTURES IN ORDER TO RECEIVE RECOMMENDATIONS
Picture guide
VIRTUAL CONSULTATION

Picture requirements

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Upload a minimum of 3 photos from a front, side, AND diagonal view of the area of interest
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Ensure you have good lighting without shadows
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Choose a plain background
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For facial procedures, take photos with both relaxed and expressive faces
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For breast and body procedures, do not include your face
Breast procedure pictures

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Face pictures

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Body procedure pictures

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Let us know how to get in touch with you!

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General
information

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FIRST NAME
LAST NAME
PHONE NUMBER
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General
information

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COUNTRY
STATE/PROVINCE
CITY
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Thank you!

Our team is reviewing your information and will reach out with personalized recommendations shortly.

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