SCHEDULE A CONSULTATION

Virtual Consultation Form

Fieldset

Are you wanting to schedule a new procedure or is this a follow-up? *
Schedule a new procedureThis a follow-up
First Name *
Last Name *
Age *
Gender
Weight
Height
Phone *
Email *
How would you like us to respond?
PhoneEmail
Areas of Concern & Procedures You are Considering:
When are you hoping to have this procedure done? *
Is there an event that is motivating you?
Have you had cosmetic surgery before?
YesNo
If yes, please indicate surgical procedures
Select How long have you been thinking about this procedure? *
On a scale of 1-10, how important is this surgery to you? *
What are your expectations & concerns of this procedure? *
Where are you in your decision-making process?
PLEASE USE THE UPLOAD BUTTON BELOW TO UPLOAD PHOTOS TO SEND TO US To make the most of your virtual consultation, do your best to submit your photographs in the following format. This will allow our doctors to make the most comprehensive assessment.
1. Use a solid background.
2. Take one frontal photo with the face or body centered and looking straight.
3. Take at least one, preferably two profile photos

File formats accepted: gif | png | jpg | jpeg
File size limit: 3mb
Photo 1 *
Photo 2
Photo 3
Photo 4
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WHAT OUR PATIENTS are SAYING

Testimonials

Center For Plastic & Reconstructive Surgery

"From the start of my treatment, for breast reconstruction from cancer, to the end of treatment I found Dr Peters and his office to be attentative caring and professional! I am quite pleased with the results of my surgery! "

- Elizabeth Liberti

Excellent patient care and reliable staff and physicians when in need. My breast reduction was a toral success. Thanks "

- Vanessa Quinones-Aponte

"Great service all around. Nice staff and doctors who know your needs and understand. Was satisfied in all aspects from the first appointment to surgery."

- Patrica Ethell