Step 1 of 7 14% Name(Required) First Name Last Name Phone(Required)Email(Required) DOB MM slash DD slash YYYY Height Weight Please choose the areas of interest:(Required) Facial Procedures Body Contouring Breast Procedures Other Concerns Facial ProceduresPlease tell us which area(s) of your face you are looking to improve. Please list them in order of importance to you.What is bothering you about those areas? Please be as specific as possible.Have you ever had any traumas or injuries to your face?Have you ever had any surgical or nonsurgical treatments performed on your face (facelift, blepharoplasty, lasers, peels, Botox, fillers, etc.)? If so, please list them, and please include approximate dates of procedures.What facial rejuvenation/skin care treatments are you interested in?Are you interested in surgical or nonsurgical treatment options (or both)?What is your ultimate goal with these treatments (i.e. want to look younger, look more refreshed, feel better about yourself, etc.)? Please list your goals in order of importance.Have you had a prior consultation with a Plastic Surgeon; if so, what was recommended?What special concerns do you have regarding cosmetic surgery?What factors do you consider important in your decision about having cosmetic surgery?What qualities do you consider important in your Plastic Surgeon?What do you want to accomplish in your consultation with the doctor?When are you hoping to have your procedure(s) performed?What do you feel may be the long-term benefits of your Plastic Surgery?Please tell us any other relevant information that will help our team to develop the best treatment plan for you. Body ContouringPlease tell us which area(s) of your body (i.e. abdomen, flanks (sides), back, inner thighs, outer thighs, buttocks, arms, etc.) you are looking to improve. Please list them in order of importance.What is bothering you about those areas. Please be as specific as possible.Have you ever had any surgical or nonsurgical treatments performed on your body? If so, please list them, and please include approximate dates of procedures.What body contouring procedures are you interested in?Are you interested in surgical or nonsurgical treatment options (or both)?What is your ultimate goal with these treatments (i.e. flatter abdomen, thinner thighs, weight loss, feel better about yourself, etc.)? Please list your goals in order of importance.How concerned are you about surgical scars on your body (i.e. not concerned, mildly concerned, extremely concerned, etc.)?Have you had any weight gains or losses? Is your weight stable or are you planning on losing weight?What is your height and weight?(Women) Have you had any children and if so how many?Have you had a prior consultation with a Plastic Surgeon: if so, what was recommended?What special concerns do you have regarding Plastic Surgery?What factors do you consider important in your decision about having Plastic Surgery?What qualities do you consider important in your Plastic Surgeon?What do you want to accomplish in your consultation with the doctor?When are you hoping to have your procedure(s) performed?What do you feel may be the long-term benefits of your cosmetic surgery?Please tell us any other relevant information that will help our team to develop the best treatment plan for you. Breast ProceduresPlease tell us what is specifically bothering you about your breasts (i.e. too small, too large, sagging, etc). Please list each concern in order of importance.Have you ever had any surgical treatments performed to your breasts? If so, please list them, and please include approximate dates of procedures.What is your current cup size and what cup size do you want to ultimately achieve?Which breast procedures are you interested in?What is your ultimate goal with these treatments (i.e. fuller breasts, lifted breasts, smaller breasts, relief of back pain, feel better about yourself, etc.)? Please list your goals in order of importance.How concerned are you about surgical scars on your breasts (i.e. not concerned, mildly concerned, extremely concerned, etc.)?Have you had any significant weight gain or loss? Is your weight stable or are you planning on losing weight?(Women) Have you had any children and if so how many?Have you had a prior consultation with a Plastic Surgeon; if so, what was recommended?What special concerns do you have regarding Plastic Surgery?What factors do you consider important in your decision about having Plastic Surgery?What qualities do you consider important in your Plastic Surgeon?What do you want to accomplish in your consultation with the doctor?When are you hoping to have your procedure(s) performed?What do you feel may be the long-term benefits of your Plastic Surgeon?Please tell us any other relevant information that will help our team to develop the best treatment plan for you. Other ConcernsPlease tell us which area(s) you are concerned about and list them in order of importance.Please tell us what is specifically bothering you about those areas.Have you ever had any surgical or nonsurgical treatments performed on these areas? If so, please list them, and please include approximate dates of procedures.What procedures are you interested in?Are you interested in surgical or nonsurgical treatment options (or both)?What is your ultimate goal with these treatments? Please list your goals in order of importance.How concerned are you about surgical scars (i.e. not concerned, mildly concerned, extremely concerned, etc.)?Have you had a prior consultation with a Plastic Surgeon; if so, what was recommended?What special concerns do you have regarding Plastic Surgery?What factors do you consider important in your decision about having Plastic Surgery?What qualities do you consider important in your Plastic Surgeon?What do you want to accomplish in your consultation with the doctor?When are you hoping to have your procedure(s) performed?What do you feel may be the long-term benefits of your Plastic Surgery? Submit Photos Please share with us photos of your area of concern below. By reviewing photos ahead of time, Dr. Buford will be better able to answer your questions during your virtual consult and assess how he will be able to help resolve your concerns. Discussing specific options based on your anatomy is very important for making the consultation a valuable experience for you. These photos are used solely for your consultation, are kept confidential, and will not be redistributed without your prior authorization. For best results: Use a solid background. Take one frontal photo with your body or face centered and facing forward. Take one or two side views with your body or face centered and facing to the right and/or left. Make sure that your area of concern is visible and not covered by clothing. For best standardization, we encourage you to have someone else take the photos from 8-10 feet away with good lighting. Photo 1(Required)Accepted file types: jpg, gif, png, jpeg, Max. file size: 50 MB.Photo 2(Required)Accepted file types: jpg, gif, png, jpeg, Max. file size: 50 MB.Photo 3(Required)Accepted file types: jpg, gif, png, jpeg, Max. file size: 50 MB.Photo 4(Required)Accepted file types: jpg, gif, png, jpeg, Max. file size: 50 MB. Terms of UseConsent By checking this box you agree to the Terms of Use below.This form is encrypted, and all of your information is securely transmitted to us via encrypted email. However, the use of any electronic communication system carries risks. We cannot guarantee the security of your information once it is received and decrypted by our office. Using the Internet and email for your consultation is for your convenience only, and by using them you assume the risk of unauthorized use. By checking this box you hereby agree to hold Dr. Buford and his affiliates harmless from hacking or any other unauthorized use of your personal information by outside parties.NameThis field is for validation purposes and should be left unchanged. Δ
Contact Us
Book Now
Contact Us
Book Now
303-951-5829
Our Location