Phone/Internet Consultation

If you live outside of the area and are unable to see Dr. Harris for an in-office consultation, we can setup a phone consultation or internet consultation via Skype. During this time you and Dr. Harris will discuss your concerns and desired results. Dr. Harris will recommend a treatment plan and explain possible beneficial surgical procedures. Following your consultation with Dr. Harris, we will provide information regarding costs for the procedure(s) that you discussed, financing options, as well as next steps.

If you are interested in beginning the consultation process via phone or internet, please complete the form below. You will be asked to provide a brief description of yourself, your concerns, and your goals. It is also very important that you attach photos in order for Dr. Harris to determine your candidacy for any surgical procedures.

Please complete the form below to begin your phone consultation process:

Required fields are marked with an asterisk *.

Title: select...MrMrsMsDr
First Name: *	Last Name: *
Email Address: *	Phone Number: *
What is your procedure of interest?: Chin Augmentation Earlobe Repair Eyebrow Lift Eyelid Lift Facelift Fat Transfer Hair Restoration Keloid Excision Lip Reduction Neck Liposuction Scar Revision Rhinoplasty
Please describe your concerns, desired results, and timeframe in which you'd like to have procedure done.:
Have you had cosmetic surgery before?: Yes No If yes, please indicate surgical procedures:
Preferred Method of Contact: Email Phone Skype
Skype Username (If Skype was selected above):
Best Time to Contact You: * select...AnytimeMorningMid-dayAfternoonEvening
If you have some photos of yourself that you would like to share, please use the upload button below to upload photos to send to us: Please attach photos of the following views: Front view of the area of concern Both right and left profile views of the area of concern Base view of the area of concern for patients discussing Rhinoplasty (head tilted back) Back view of head (for patients discussing hair restoration) Example frontal view. Example base view.     Example side view. Example back view.
Photo 1:	Photo 2:
Photo 3:	Photo 4:
Contact Date: