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Section 2 of 3
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Website
Friend or Family
Instagram
Facebook
Google
OTHER
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Abdominoplasty
Blepharoplasty ~ Eye Lid Procedure
Body Lift
Breast Augmentation
Mastopexy ~ Breast Lift or Reducation
Brow Lift
Buccal Fat Pad Removal
Buttock Lift
Face Lift
Fat Grafting ~ Stem Cell Fat Transferring
Gynecomastia
Liposuction
Neck Lift
Hair Transplanting
Otoplasty ~ Pinning Ears Back
Rhinoplasty or Septoplasty
Abdominal Etching
Other…
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Section 3 of 3
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Please note a Gmail email account is required to complete this online consultation.
If you would like pricing to be sent prior to scheduling your consultation please complete the demographics and questions by clicking NEXT.
Personal Information
Legal Name (First, Middle, Last):
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Date of Birth:
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Mailing Address (City, State, Zip):
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Phone/Cell:
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How did you hear about Dr. Do?
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What procedures are you interested in?
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Please describe any goals or expectations that you are wanting to achieve.
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Do you have any medical conditions?
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Have you ever had a STAPH or MRSA infection?
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Do you take any prescriptions prescribed by a physician? ...if so please list below.
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Are you taking any supplements or over the counter medication at this time? ...if so please list below.
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Do you need have a time frame for surgery?
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If specific time frame for surgery please include dates requesting below.... *
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*Please upload photos for your evaluation and include a LEFT, RIGHT & FRONTAL photo. (straight on & in good lighting is best) If considering body contouring please include your back side image for a 360 evaluation.Note: If you are inquiring about a body procedure only, you do not need to include your face. Photos received will be evaluated so that pricing and your tailored surgical plan can be sent via email along with any additional information to help make your surgical plans a reality.
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