Virtual Consultation

Receive a private, confidential consultation with our doctors without leaving home.

Our doctors ask that you include 4 photographs of the area you want to improve so that we can determine the best approach to treatment. These photos can be attached in the contact form below.

Also, please include a few sentences describing your surgical goals and the results you would like to achieve. Our doctors will review your submission thoroughly to decide whether you are a good candidate for surgery. If so, we will have our patient care coordinator contact you to discuss your doctor’s evaluation of your submission and explain options for you to take the next step.

Your Information

All information you provide is kept confidential. We do not distribute your personal data to any person or organization outside of our office.

Required fields are marked with an asterisk *.

    *

    What type of results are you hoping to achieve?

    Have you had cosmetic
    surgery before?

    If yes, please indicate surgical procedures:

    How would you like us to reply?

    If you have some photos of yourself that you would like to share, please use the upload button below to send them to us. For best results:

    • Use a solid background.

    • Take one frontal photo with your body or face centered and facing forward.

    • Take one or two side views with your body or face centered and facing to the right and/or left.

    Example of a good photo

    Example frontal view.

    Example of a good photo

    Example frontal view.

    Example of a good photo

    Example side view.

    Example of a good photo

    Example side view.





    Terms of Use

    This form is encrypted, and all of your information is securely transmitted to us via encrypted email. However, the use of any electronic communication system carries risks. We cannot guarantee the security of your information once it is received and decrypted by our office. Using the Internet and email for your consultation 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 Dr. Clark and her affiliates harmless from hacking or any other unauthorized use of your personal information by outside parties.