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*
Phone
*
Email
*
Birthday
*
Height (ft.)
*
Height (in.)
*
Weight
*
Height Total
BMI
*
Using hormones/birth control/IUD?
*
Yes
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Nicotine within past month?
*
Yes
No
History of blood clots, bleeding, diabetes, autoimmune conditions (lupus, Crohn’s), >2 miscarriages, or malignant hyperthermia?
*
Yes
No
Procedure Timeframe
*
Soonest available
Within 1 month
Within 2-3 months
Payment method
*
Credit card, debit, cash or check
$0 down payment plan
>$1k downpayment + payment plan
Payment plan details
*
Already have CareCredit, Alphaeon, or other
Need pre-approved: credit >640
Need pre-approved: credit >580-639
Need co-signer: credit <580
Already have co-signer with credit > 640
I don’t need payment plan
Request Consultation
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In-person (1-hour slots, $150, open until 8pm weekdays)
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Book Consultation – Tummy Tuck
Call For Consultation:
817.912.1410
We would love to hear from you! Please fill out this form and we will get in touch with you shortly.
Full name
*
Phone
*
Email
*
Birthdate
*
Date Format: MM slash DD slash YYYY
Height (ft.)
*
Height (in.)
*
Weight (lbs.)
*
Height Total
BMI
Procedure of interest
*
Using hormones/birth control/IUD?
*
Yes
No
Nicotine within past month?
*
Yes
No
History of blood clots, bleeding, diabetes, autoimmune conditions (lupus, Crohn’s), >2 miscarriages, or malignant hyperthermia?
*
Yes
No
Procedure Timeframe
*
Soonest available
Within 1 month
Within 2-3 months
Payment method
*
Credit card, debit, cash or check
$0 down payment plan
>$1k downpayment + payment plan
Payment plan details
*
Already have CareCredit, Alphaeon, or other
Need pre-approved: credit >640
Need pre-approved: credit >580-639
Need co-signer: credit <580
Already have co-signer with credit > 640
I don’t need payment plan
Request Consultation
*
Virtual (most popular)
In-person (1-hour slots, $150, open until 8pm weekdays)
Submit Picture(s)
Drop files here or
Accepted file types: jpg, gif, png, pdf.
Allowed File Extensions: jpg, gif, png, pdf
Maximum File Size: 10MB Per Photo
Maximum Number of Files: 5
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Book Consultation - Butt Lift
Call For Consultation:
817.912.1410
We would love to hear from you! Please fill out this form and we will get in touch with you shortly.
Patient Information:
Legal Full Name
*
Phone Number
*
Email Address
*
Date of Birth
*
Date Format: MM slash DD slash YYYY
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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Book Consultation
Call For Consultation:
817.912.1410
We would love to hear from you! Please fill out this form and we will get in touch with you shortly.
Patient Information:
Legal Full Name
*
Phone Number
*
Email Address
*
Date of Birth
*
Date Format: MM slash DD slash YYYY
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
×
Book Consultation - Breast Augmentation
Call For Consultation:
817.912.1410
We would love to hear from you! Please fill out this form and we will get in touch with you shortly.
Patient Information:
Legal Full Name
*
Phone Number
*
Email Address
*
Date of Birth
*
Date Format: MM slash DD slash YYYY
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
×
