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Inquiry For Consultation

If you wish to book yourself a private consult, please complete the form below. Private consults can be booked within 4-6 weeks. Depending on the procedure, surgery can be booked within 6-8 weeks. A full, written consultation report will be provided to you. At this time we are only able to offer surgery to Canadian residents.

FIRST NAME
LAST NAME
HEIGHT
WEIGHT
EMAIL*
PHONE
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EXT
STREET ADDRESS
CITY
STATE/PROVINCE
POSTAL/ZIP CODE
Best time to call:
Morning
Afternoon
Have you had previous cosmetic surgery?
If yes what type of surgery and when:
Comments:

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