Plastic Surgery Consultation

To learn more, please complete the form below so that we may contact you to schedule your appointment.

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* First Name:
* Last Name:


* Address:
Suite/Apt:


* City:
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Country:


* Phone Number:


* E-Mail Address:


Procedures you are interested in:
Face Lift
Nose Reshaping

Eyelid Improvement
Facial Implants

Liposuction
Tummy Tuck

Upper Arm LIft
Lower Body Lift

Thigh Lift
Buttock Lift

Body Implants
Breast Augmentation

Breast Lift
Breast Reduction

BOTOX©
Injectable Fillers

Fat Injection
Lip Augmentation

Abdominal Etching
Gynecomastia Correction




Best way to contact
Please contact me by telephone
Please contact me by e-mail



Questions or Comments:


 

Cancellation Policy: Please note that if you do not call us to cancel or reschedule your appointment at least 24 hours in advance, a $100 fee will be assessed to you.

Consultation and Patient Information

Patient Information

Click on the following link to download new patient forms and other information before your consultation.

New Patient Form (PDF)

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Patient Survey

We look forward to hearing about your experience. Please take a couple of minutes to complete our survey.

Services were provided by: (select all that apply)

Dr. Geldner
Dr. Iteld
Our Aesthetician

Overall how satisfied were you with our service; from your initial phone call to our practice, your consultation, your procedure, to your follow-up appointment?

How were you treated by our staff and physicians?

I would recommend
The Geldner Center to my family and friends?
Yes No

I would return to
The Geldner Center for other procedures and treatments.
Yes No

Additional Comments: