Virtual Consultation Form

You can have a consultation with Dr. Kaufman or Dr. Clark in the privacy of your own home!

If you're interested in a preliminary, complimentary evaluation in the privacy of your home, or if you simply have a question, please complete the form below. If you're from out of the area, in addition to completing this form please read our information on flying into Sacramento for your plastic surgery procedure.

Dr. Kaufman and Dr. Clark are happy to review your photographs and feels this is a necessary part of the virtual consultation. Please send us two to four photos of the area you wish to have evaluated and a description of your surgical goals for the doctors to review. After taking the opportunity to carefully examine your submission, our staff will set up a time for a telephone conference so you and and the doctor of your choice can discuss his expert opinion and recommendations.

If you are interested in hearing more and meeting with Dr. Kaufman or Dr. Clark in person, our staff will be happy to schedule a consultation where you can further discuss your interests and take advantage of an on-site meeting.

Required fields are marked with an asterisk *.

Personal Information

Your personal information will not be shared with, or sold to, anyone outside of our organization for any reason.

Title: Select One Mr. Mrs. Ms. Dr.
Your First Name: *	Your Last Name: *
Age:	Gender: ---- Female Male
Email: *	Day Phone:
Height:	Weight:
Measurements:
Areas of Concern:
What type of results are you hoping to achieve? More Athletic Younger	Healthier Cosmetic Correction
Other notes:
When are you hoping to have this procedure done? Please select a time frame: Within 1 Month 1-2 Months 3-6 Months 6 Months or more	Is there an event that is motivating you? Please select an event: Wedding Class Reunion Birthday Family Reunion None of these
I would prefer my consultation to be with: * Dr. Christa Clark Dr. David Kaufman
Have you had cosmetic surgery before? Yes No If yes, please indicate surgical procedures:
How would you like us to reply? Email Phone
If you have some photos of yourself that you would like to share, please use the upload button below to upload photos to send to us: To make the most out of your virtual consultation, do your best to submit your photographs in the following format. This will allow Dr. Kaufman and Dr. Clark to make the most comprehensive assessment. Use a solid background. Take one frontal photo with the face or body centered and looking straight. Take at least one, preferably two profile photos. Example frontal view. Example profile view. Example body frontal view. Example body profile view.
Photo 1:	Photo 2:
Photo 3:	Photo 4:

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