Virtual Consultation Form

Personal Information

Please complete the form below for a preliminary, complimentary evaluation.

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

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Cosmetic Correction

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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 to make the most comprehensive assessment.

  1.    Use a solid background.
  2.   Take one frontal photo with the face or body centered and looking straight.
  3.   Take at least one, preferably two profile photos.
consultation front view
Example frontal view.
consultation side profile
Example profile view.
consultation body front view
Example body frontal view.
consultation body side view
Example body profile view.

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Communications through our website or via email are not encrypted and are not necessarily secure. Use of the internet or email is for your convenience only, and by using them, you assume the risk of unauthorized use. By checking this box you hereby agree to hold Kaufman Plastic Surgery, its doctors and affiliates, harmless from any hacking or any other unauthorized use of your personal information by outside parties.