Survey

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?
YesNo


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



Soft



Size & Volume



Cleavage


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



Artist



Finance options



Good Listener



Quality of Staff



Recommended by my physician/friends/family



Cost


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: