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Surgical Evaluation Form

Please complete this confidential form for your FREE Surgical Assessment from one of our board-certified Plastic & Reconstructive Surgeons.

A false declaration may result in the rejection of surgery by the surgeon at the time of consultation after your arrival. Diabetes may affect and delay the healing and scar tissue of the skin, resulting in additional medical attention and hospitalization at additional cost to you, the patient.

Please note that a confirmed treatment plan can only be provided when you are examined by the Surgeon. All quotations provided are estimated costs of the procedure requested. All estimates given are subject to change.

Assessment details

How To Take Your Surgery Assessment Photos

Arm Procedures

4 PHOTOS ARE REQUIRED FOR ARM PROCEDURES Front Right Arm, Front Left Arm, Back Right Arm, Back Left Arm

  • DO Take photos on a clear, uncluttered background
  • DO Make sure your photos are crisp and clear, blurry photos will not be accepted
  • DO Try to have someone else take your photo if possible , self-taken photos can be distorted
  • DON’T Take group photos
  • DON’T Take photos in a darkly lit room or shadow your body
  • DON’T Distort your body, follow the pictured instructions below

*Photos must be minimum of 150k in size and a maximum of 2000k in size your photos like your all information is kept strictly confidential and will only be seen by your consultant and surgeon.

Tummy Procedures

6 PHOTOS ARE REQUIRED FOR STOMACH PROCEDURES Front, Right Side, Left Side, Backside, Leaning Left, Leaning Right KEEP YOUR HANDS AWAY FROM THE AREA – THOUGH, DO NOT STRETCH YOUR ARMS AWAY

  • DO Take photos on a clear, uncluttered background
  • DO Make sure your photos are crisp and clear, blurry photos will not be accepted
  • DO Try to have someone else take your photo if possible , self-taken photos can be distorted
  • DON’T Take group photos
  • DON’T Take photos in a darkly lit room or shadow your body
  • DON’T Distort your body, follow the pictured instructions below

*Photos must be minimum of 150k in size and a maximum of 2000k in size your photos like your all information is kept strictly confidential and will only be seen by your consultant and surgeon.

Breast Procedures

3 PHOTOS ARE REQUIRED FOR BREAST PROCEDURES Front, Right Side, Left Side KEEP YOUR ARMS BY YOUR SIDES

  • DO Take photos on a clear, uncluttered background
  • DO Make sure your photos are crisp and clear, blurry photos will not be accepted
  • DO Try to have someone else take your photo if possible, self-taken photos can be distorted
  • DON’T Take group photos
  • DON’T Take photos in a darkly lit room or shadow your body
  • DON’T Distort your body, follow the pictured instructions below

*Photos must be minimum of 150k in size and a maximum of 2000k in size your photos like your all information is kept strictly confidential and will only be seen by your consultant and surgeon.

Face Procedures

5 PHOTOS ARE REQUIRED FOR FACE PROCEDURES Front, Right Side, Left Side, 45 Degree Right, 45 Degree Left KEEP YOUR HAIR OFF YOUR FACE + NECK, PUT YOUR HAIR UP IF NEED BE.

  • DO Take photos on a clear, uncluttered background
  • DO Make sure your photos are crisp and clear, blurry photos will not be accepted
  • DO Try to have someone else take your photo if possible , self-taken photos can be distorted
  • DON’T Take group photos
  • DON’T Take photos in a darkly lit room or shadow your body
  • DON’T Distort your body, follow the pictured instructions below

*Photos must be minimum of 150k in size and a maximum of 2000k in size your photos like your all information is kept strictly confidential and will only be seen by your consultant and surgeon.

Nose Procedures

7 PHOTOS ARE REQUIRED FOR NOSE PROCEDURES Front, Right Side, Left Side, 45 Degree Right, 45 Degree Left, Looking Up, Looking Down KEEP YOUR HAIR OFF YOUR FACE + NECK, PUT YOUR HAIR UP IF NEED BE.

  • DO Take photos on a clear, uncluttered background
  • DO Make sure your photos are crisp and clear, blurry photos will not be accepted
  • DO Try to have someone else take your photo if possible , self-taken photos can be distorted
  • DON’T Take group photos
  • DON’T Take photos in a darkly lit room or shadow your body
  • DON’T Distort your body, follow the pictured instructions below

*Photos must be minimum of 150k in size and a maximum of 2000k in size your photos like your all information is kept strictly confidential and will only be seen by your consultant and surgeon.

Thigh Procedures

4 PHOTOS ARE REQUIRED FOR THIGH PROCEDURES Front, Right Side, Left Side, Backside

  • DO Take photos on a clear, uncluttered background
  • DO Make sure your photos are crisp and clear, blurry photos will not be accepted
  • DO Try to have someone else take your photo if possible , self-taken photos can be distorted
  • DON’T Take group photos
  • DON’T Take photos in a darkly lit room or shadow your body
  • DON’T Distort your body, follow the pictured instructions below

*Photos must be minimum of 150k in size and a maximum of 2000k in size your photos like your all information is kept strictly confidential and will only be seen by your consultant and surgeon.