Patient Registration

Step 1 of 4 - Plastic/ Cosmetic Surgery Questionnaire

  • Date Format: MM slash DD slash YYYY
  • A. Please indicate the following services, products, procedures and/or health issues of interest to you. Dr. Diamantis will be glad to review these particular interests with you. (Please check all the boxes that apply).
  • B. Please answer the following questions on a scale between 1 -5 by checking the range you feel is most appropriate.
  • C. How did you hear of our practice? A referral from a previous patient is the highest honor you can bestow on us.

    Please provide their full surname & email so we may formally thank them.