• Teleconsultation Request

    1. Please complete the information required below. 
    2. If you have already sent in your medical information you will not need to submit again.  Please indicate YES, please use my existing information and advance to the last page, and submit. 
    3. Your Destination Manager will confirm timing and surgeon availability in advance of the session.
    4. If the dates are not available, alternate dates will be provided.
    5. All teleconsultation instructions and access will be provided at least 48 hours prior to your session. Please ensure you notify us with 24 to 48 hours of your scheduled session if you are unable to attend and we will reschedule. 
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  • Patient Information

    Please complete the information below
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  • Surgery Details

    Please tell us the procedures you are interested in
  • Browse Files
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  • When are you planning to have your surgery done ? 

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  • Medical

    Please complete both the family and patient medical sections
  • Your Family Medical

    Please indicate if you have a history of these conditions in your family. 

  • Your Personal Medical

    Please indicate if you have any of these conditions.

  • Habits

    Please describe your current personal habits
  • Women

    This section is for women only
  • Breast Surgery Clients

    (Please complete if having breast surgery)

  • Photos or Files

    Please upload your photos securely.
  • Please upload your photos or requested files.  These will be sent to the surgeon for a FIRMQUOTE and customized feedback.  Once your firmquote is ready, the teleconsultation will be scheduled.

    The following are guidelines for submitting photos your photos:

    Requirements For Breast Surgery Photos:

    From the neck to the waist without undergarments and with both arms down the side, as if standing to attention.

    Front view,

    Left Profile

    Right Profile 


    Facial  Photos;
    Left Profile
    Right Profile
    Front On
    Head Tilted Backwards
    Head Tilted Downwards
     

    Mommy Makeover, Tummy Tuck and Liposuction Photos:

    From the neck to the feet without undergarments
    Left Profile
    Right Profile
    Front On
    Back On
     

    Thigh Lift Photos:


    Left Profile – Showing Inside Thigh
    Right Profile  – Showing Inside Thigh
    Left Profile – Showing Outside Thigh
    Right Profile  – Showing Outside Thigh
    Front On
    Back On

    Arm  Photos:


    Left Arm Raised At Side Of Body
    Right Arm Raised At Side Of Body

  • Upload Files
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  • Thank You for Completing!

    PLEASE PROVIDE YOUR CONSENT BELOW
  • Your Destination Manager will be in touch with you soon.

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