Online Consultation

Step 1: Completely Fill out the Form at the Bottom of this Page.

Step 2: Take the Photos

Have the six(6) required pre-operative photos taken of the area of the body you wish to improve. The photo set should include two(2) side views, two(2) three-quarter views, one(1) forward facing, and one(1) with the area of the body tilted back. Please view the examples below as reference.

In order for our doctor to adequately assess your candidacy, the photos must be taken in good lighting against a solid-colored background. There should be no shadows on the face. You can take the photos at home, using any camera with a zoom lens, by fully zooming in on the face. However, ordinary point-and-shoot cameras are not recommended because they distort the image too much for the resulting photos to be helpful. You may also have the pictures taken at any portrait studio.

Step 3: Submit the Forms, Photos, and Fee

Gather:

  • All completed forms
  • All requested photos
  • If you live in the state of Georgia, we are requesting you be seen in person and there is a $100 consultation fee (non refundable – but can be applied toward procedure). No fee for out of state quotes.

e-mail the forms and photos to: [email protected]

Step 4: Hear Back From Us

Our office will contact you via e-mail with the results of your screening.

    Medical History

    Do you or have you ever had any of the following?

    Rheumatic Fever

    YesNo

    Heart Trouble

    YesNo

    Heart Murmurs

    YesNo

    Heart Palpitations

    YesNo

    Irregular Heart Beat

    YesNo

    Chest Pains

    YesNo

    Shortness of Breath

    YesNo

    Swelling of Ankles

    YesNo

    High Blood Pressure

    YesNo

    Herpes "Fever Blister"

    YesNo

    Chronic Lung Problems

    YesNo

    Herpes "Diabetes"

    YesNo

    Cancer

    YesNo

    Kidney Problems

    YesNo

    Eye Diseases

    YesNo

    Hepatitis

    YesNo

    Thyroid Problem

    YesNo

    Asthma

    YesNo

    Anemia

    YesNo

    Blood Disorders

    YesNo

    Skin Disorders

    YesNo

    Trouble with dryness, soreness, burning, itching, or excessive tearing of eyes

    YesNo

    Any other serious illness

    YesNo

    Have you ever had MRSA (Methicillin-resistant Staphylococcus aureus)

    YesNo

    Bleeding/Scarring/Anesthesia:

    Do you or any member of your family have difficulty with prolonged bleeding when cut?

    YesNo

    Do you or a member of your family bruise easily?

    YesNo

    Do you have a problem with excessive scarring or have you ever formed a keloid after being cut?

    YesNo

    Have you or any member of your family ever had a problem with anesthesia?

    YesNo

    Personal History

    Have you ever had any psychiatric problems, a nervous breakdown or been under the care of a psychiatrist?

    YesNo

    Do you smoke?

    YesNo

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