Springs Aesthetics - Virtual Consultation Form

If you're interested in one of our services please give us a call at (719) 473-8801!
First Name*
Last Name*
Age*
Gender
Phone*
Email*
Patient Type*
Treatment Type*
Areas Of Concern
Any medical issues or medications you are taking?
When do you want have this done?*
Is there an event motivating you?
Have you had cosmetic surgery before?
If yes, indicate surgical procedures
How long have you been thinking about cosmetic surgery?*
On a scale of 1-10, how important is this surgery to you?*
What are your expectations and concerns of this procedure?
Where are you in your decision-making process?
To make the most of your virtual consultation, do your best to submit your photographs in the following format. This will allow our doctor to make the most comprehensive assessment.

1. Ensure your lighting is good and your photos are clear and in focus. If possible, have someone take them for you.
2. Take one frontal photo with the face or body centered and looking straight.
3. Take at least one, preferably two, photos of the area(s) of concern.
Photo 1

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Photo 2

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Photo 3

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Photo 4

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Please verify that you are human*
By submitting this form, you agree to be contacted by phone, email or text and that any associated call may be recorded for quality and training purposes. This form should not be used to transmit private health information, and we disclaim all warranties with respect to the privacy and confidentiality of any information submitted through this form.
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If you're interested in one of our services please give us a call at (719) 473-8801!