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EDUCATION:
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Number of years in Elementary
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Number of years in High School
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Number of years in College
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With OCCUPATION?
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OCCUPATION:
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HOW LONG?
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Type/s of surgery you're considering:
• • •
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OTHER
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What specific features do you dislike?
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How long have you been thinking about having surgery?
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What caused you to begin thinking about having it?
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Have you read articles in newspapers, magazines, or books about cosmetic surgery?
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Do you understand that the object of any cosmetic operation is improvement in appearance, not perfection?
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Has anyone in your family or a friend had cosmetic surgery?
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What was done?
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Did you discuss the operation with them?
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Why did you wait until now to come in for correction?
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How did you happen to select us for consultation?
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Have you consulted any other surgeon?
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Why didn't you have him do the work?
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Is having surgery your idea or is someone else urging you to have it?
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Do you feel embarrassed about wanting the operation?
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