Virtual Consultation

Searching for the best plastic surgeon in the perfect location can be a daunting and time-consuming task. Once you have found “the one,” it can be tough to find the time, or the funds, to travel to the office for a consultation. With our virtual consultation page, you can stay in the comfort of your own home—even if it’s halfway across the country. This time-saving feature gives you the opportunity to fill out the form, submit your photos, and ask any questions you may have to get you one step closer to your rejuvenation journey.

Name(Required)

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Age

Gender

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Current Height

Current Weight

Address

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How would you like us to respond?

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How were you referred to Premiere Center?

Have you had Cosmetic Surgery before?

Have you had surgery of any kind under general anesthesia?

Yes

No

Are you currently taking any medications?

Yes

No

Have you had children?

Yes

No

Are you a smoker?

Yes

No

What Procedure(s) are you interested in?

Please tell us more about the areas of concern and what do you hope to accomplish with this procedure?

How important is this surgery to you?

I am ready (Want surgery within 1 Month)

Very Important (Want surgery within 1-2 Months)

Important (Want surgery within 3-6 Months)

Still Thinking (Want surgery within 6 Months or more)

What would influence your decision to have this surgery?

Guidelines to upload your photos:
 

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