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What procedure are you interested in?
What procedure are you interested in?
Brazilian Butt Lift via Fat Transfer
Brazilian Butt Lift via Butt Implants
Brazilian Butt Lift via Butt Implants & Fat Transfer
Breast Augmentation with Saline Implants
Breast Augmentation with Silicone Implants
Breast Agumentation with Lift
Breast Lift
Breast Reduction
Gynecomastia (Male Breast Reduction)
Liposuction
Tummy Tuck
Mini Tummy Tuck
Mommy Makeover
Vaginal Rejuvenation
Vaginoplasty
Labiaplasty
Rib Remodeling
Brachioplasty
Thigh Lift
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Back Lift (Braline Lift)
Vaser Liposuction
Vaser Lipo Etching
Aveli Cellulite Treatment
j-plasma
Morpheus8
Otoplasty
Blepharoplasty (Eyelid Surgery)
Lip Augmentation
Upper lip lift
Do you have any medical problems? Please List them.
Have you had any previous surgeries? Please List them.
What medications do you take on a daily basis?
Do you smoke?
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How much and for how many years
Are you interested in having multiple procedures done at the same time?
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How do you plan to pay for the procedure?
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Are you interested in any type of breast surgery?
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No
How many children have you had?

Did you breast feed?
Yes
No
For how long on average
Do you plan on having children in the future?

Yes
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Have you had any problems with your breasts (such as cysts, lumps, abnormal discharge, skin changes, etc)?
Yes
No
Please list
Have any close relatives had breast cancer?
Yes
No
The last mammogram I had was:
The last mammogram I had was:
Never had one
Less than one year ago
More than one year ago
What type of implants are you interested in?
The last mammogram I had was:
Saline
Silicone
Not Sure
What Bra size do you currently wear?
What cup size do you want to be after surgery (approximate)?
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