Virtual Consultation


To expedite our service please fill out this form below. Thank you.

Patient information

  • Date Format: MM slash DD slash YYYY
  • Photos

    Take at least 1 photo of each area and attach the photos below.

    • Only take selfies for face procedures
    • Have someone else take the photo or use a mirror for breast or body procedures
    • For face procedures, only include a picture of your face
    • For body or breast procedures, you do not need to include your face
    • Make sure the area you are concerned with is completely undressed
  • Drop files here or
  • Drop files here or
  • Drop files here or
  • Date Format: MM slash DD slash YYYY
  • Communications through our website or via email are not encrypted and are not necessarily secure. Use of the internet or email to communicate with Pure Plastic Surgery is for your convenience only, and by using them, you assume the risk of unauthorized use. By checking this box you hereby agree to hold Pure Plastic Surgery, its doctors, affiliates and vendors, harmless from any hacking or any other unauthorized use of your personal information by outside parties.
  • This field is for validation purposes and should be left unchanged.