Virtual Consultation

VIRTUAL CONSULTATION

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

Patient information

  • Upload 3 to 6 Photos
  • Drop files here or
    Accepted file types: jpg, jpeg, png.
    • 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.