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817.912.1410

500 N. Carroll Ave, Suite 110
Southlake, Texas 76092

Serving all of Dallas, Fort Worth Areas

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Patient Information:
Legal Full Name*
Phone Number*
Email Address*
Date of Birth*
Height (ft.)*
Height (in.)*
Weight (lbs.)*
Height Total
BMI
*BMI 30 or less is required for surgical safety.
Procedure(s) wanted:*
How soon do you want surgery?*
- ASAP
- Within 1 month
- Within 3 months
At my consultation this week, when I schedule my procedure I plan to pay:*
- $0 down
- $1,000 down
- More than $1,000 down
Nicotine/tobacco use:*
- Never
- Occasional
Any history of blood clots, bleeding disorders, autoimmune conditions (like Lupus or Crohn's disease), diabetes, or 3 or more miscarriages?*
- Yes
- No
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Name*
Email*
Phone*
Height (in.)*
Weight (lbs.)*
Procedure(s) Interested In*
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Vennemeyer Plastic Surgery

500 N. Carroll Ave, Suite 110
Southlake, TX 76092

Phone: (817) 912-1410
Serving all of Dallas, Fort Worth, Colleyville and Keller

5.0 stars - based on 48 reviews

Business Hours:
Monday, Tuesday, Thursday, Friday
9:00am to 7:00pm

Wednesday
9:00am to 5:00pm

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HOME
DR. VENNEMEYER
BREAST
BODY
FACE
BEFORE & AFTER
SCHEDULE A CONSULT
FINANCING
CONTACT US