How long have you been considering breast augmentation?

What are your biggest concerns about breast augmentation?

Do you have any friends who have had breast augmentation surgery?

Have you had any other surgical consults?

Do you have any special events coming up for which you would like to ‘Elevate Your Look?

If you answered yes above, what kind of event?

When thinking about your desired outcome from breast augmentation, rank the following descriptors in order of importance to you (1-5, 1 most important)

Natural Shape

Youthful Perky


Size & Volume


Choose the profile that best represents your desired look (pick A, B, C or D):

When thinking about your ideal surgeon, please rank the following in order of importance to you (1-8, 1 most important):

Surgical Experience / Number of operations performed

Surgical Training / Board Certification in Plastic Surgery


Finance options

Good Listener

Quality of Staff

Recommended by my physician/friends/family


What resources have you used in thinking about breast augmentation?

If other, please describe:

How would you describe your lifestyle?

What time frame do you have in mind for completing your enhancement surgery?

What other information are you interested in to help you with your decision?

Please provide your information below:

Your Name (required)

Your Email (required)

Your Phone Number

Any questions or comments?

How do you prefer to be contacted: