Face & Neck Face Lift & Neck LiftLip LiftFat GraftingNeck Lipo Nose Rhinoplasty Eyes & Ears Upper BlepharoplastyLower BlepharoplastyOtoplasty – Ear Reconstruction
Consultation Request Form Consultation Request Notify First Name*Last Name*SexSex*FemaleMaleEmailPhone/MobileBirthdateAddress Line 1*City*State*Zip Code*Are you a current smoker or regularly use nicotine-containing products? Yes No OtherOther:Best time to contact youHow did you hear about Dr. Novis?Procedure(s) of interest Facelift & Necklift Liplift Upper Blepharoplasty Neck Liposuction Rhinoplasty Lower Blepharoplasty Otoplasty/Ear Fat GraftingWhat previous treatments have you had performed on your face/neck/body? Choose all that apply. Renuvion/FaceTite Facelift/Necklift/Mini-lift Lower Blepharoplasty Sculptra Radiesse Ultherapy/Thermage Laser resurfacing Threadlift Procedures RF Microneedling (e.g. Morpheus8) None of the above Other (Please specify)Are you currently taking Ozempic, Wegovy, Mounjaro or any other semaglutide product for weight loss?What medical conditions do you have?*Current Medications*Allergic to any medications?*I understand that Dr. Novis’s fee for The CURRENT Lift (Deep plane Facelift and Necklift under local anesthesia) starts at $27,500 I understand that Dr. Novis’s fee for The CURRENT Lift (Deep plane Facelift and Necklift under local anesthesia) starts at $27,500When are you interested in having surgery?*What cosmetic or functional surgeries have you had in the past? Please list procedure and date of service*Did you experience any complications from these procedures? If so, please explain below:Are you pleased with your previous plastic surgery or aesthetic procedures? If you were not, please explain below: Thank you for providing this essential information. Dr. Novis and her team devote exceptional care and attention to every detail throughout the consultation and surgical process. We appreciate your contribution and look forward to staying in touch with you. To finalize and submit your form, kindly upload digital photos of your face and neck for evaluation by Dr. Novis and her team. High-quality photos are crucial for precise and thorough assessments, enhancing the effectiveness of remote cosmetic consultations. Please find a well-lit room with natural light and a neutral background. Have someone assist you in taking the photos from a few feet away. Ensure your hair is pulled back, the camera lens is at eye level, and your chin is parallel to the floor. Make sure your face and neck are fully visible in the frame. Thank you! Please view our instructions on how to take your photos View Do’s & Don’ts Front UploadUpload Front* Left ProfileUpload Left Profile* Right ProfileUpload Right Profile* Left 45 Degree AngleUpload Left 45 Degree Angle* Right ObliqueUpload Right 45 Degree Angle* Please note, communications through our website or via email are not encrypted and are not necessarily secure. By submitting this form, you are granting CURRENT Facial Plastic Surgery & Medical Spa permission to review your photos. These photos will only be used in-house for consultation purposes.* Please note, communications through our website or via email are not encrypted and are not necessarily secure. By submitting this form, you are granting CURRENT Facial Plastic Surgery & Medical Spa permission to review your photos. These photos will only be used in-house for consultation purposes.*Submit
