Cosmetic Surgery Consultation

To schedule a consultation, please fill out the form below to connect with our Patient Care Coordinator. Our Patient Care Coordinator will answer most of your questions and gain a clear understanding of your needs and goals. This initial step helps us tailor our approach to your unique situation. If you’re deemed a suitable candidate and wish to move forward, you’ll have the opportunity to discuss your options further with Dr. Alexander. Please rest assured that any information you share with us will be handled with the utmost confidentiality.

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1. Your Information
2. Health Profile
3. Additional Information

1. Your Information

First Name*

Last Name*

Phone*

Email*

2. Health Profile

What is your primary reason for seeking a consultation with Dr. Alexander?

Please specify

Have you had any previous facial surgery or treatments?

Please briefly describe the procedure(s) and the date(s) of treatment

Do you have any medical conditions or allergies that we should be aware of?

Please list them

Are you currently taking any medications or supplements?

Please list them

What are your main goals or expectations for the procedure(s) you are interested in?

Have you previously consulted with another plastic surgeon or facial specialist regarding the procedure you are considering?

What was discussed during the consultation?

Please confirm that you understand there is a consultation fee for your appointment.

How did you hear about our practice?

Please specify

3. Additional Information

When is your desired time for surgery?

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