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Dr. Quiroz is a featured expert on RealSelf

 

VIRTUAL CONSULTATION

The first step of any plastic surgery procedure is to meet with one of our board certified plastic surgeons. At that meeting, you can explain your cosmetic and surgical goals, and in return get an evaluation of how realistic your expectations may be. It is also a good time for the doctor to give you some preliminary thoughts and advice on procedures you may need or not need, as well as any risks involved. 

Today, thanks to the Internet, you can have your first consultation with a CosMed plastic surgeon in the privacy of your own home. 

Simply fill out the form below as completely as possible and submit. To best help you please send us your photos: front, back and profile views of the area of your face or body that you are interested in having a consultation for a procedure. Images can be sent directly to cosmed@cosmedclinic.com, with subject line "Images for Virtual Consultation"

After we receive your submission, we will call you and you will have the opportunity to discuss your plastic surgery needs via a complementary telephone conference with one of our doctors. Then we will send you an estimate from CosMed.

*We Respect your Privacy
Please note that we keep you personal information private. Any information you submit will only be used for the purposes of your virtual consultation.

Please fill out the form below to start your Virtual Consultation.

First Name
Last Name
Evening Phone
Day Phone
Email
Clinical Information
Date of Birth	Month... January February March April May June July August September October November December Day... 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year... 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Gender	Select one... Female Male
Height	Select one... 4 feet 01 inches 4 feet 02 inches 4 feet 03 inches 4 feet 04 inches 4 feet 05 inches 4 feet 06 inches 4 feet 07 inches 4 feet 08 inches 4 feet 09 inches 4 feet 10 inches 4 feet 11 inches 5 feet 00 inches 5 feet 01 inches 5 feet 02 inches 5 feet 03 inches 5 feet 04 inches 5 feet 05 inches 5 feet 06 inches 5 feet 07 inches 5 feet 08 inches 5 feet 09 inches 5 feet 10 inches 5 feet 11 inches 6 feet 00 inches 6 feet 01 inches 6 feet 02 inches 6 feet 03 inches 6 feet 04 inches 6 feet 05 inches 6 feet 06 inches 6 feet 07 inches 6 feet 08 inches 6 feet 09 inches 6 feet 10 inches 6 feet 11 inches
Weight
Please tell us about any current and past medical history:
What are your areas of concern?
How soon are you hoping to have this procedure done?
Have you ever had plastic surgery? Yes No (If yes, please explain below)
What is the best way and time to contact you?
Additional Comments/ Questions?

Note: Please be aware that this is a non-secure communication.