Out-of-Town Patient Consultation Request Form

If you'd like to set up a free cosmetic consultation by phone or Skype, simply fill out the form below and my office will call you back at the phone number provided to secure a date and time for you and I to discuss your cosmetic surgery goals.

I answer all messages and questions sent through the contact forms personally, so please feel free to make ample use of the optional "additional comments and/or questions" field if you'd like me to address any questions you have about the procedure(s) you are interested in.

- Dr. Bill DeLuca


Include Photos with Your Form

Including photos is entirely optional at this point in the process but certainly very helpful as they make it posible for Dr. DeLuca to accurately assess the viability of your cosmetic goals and answers the questions you may have as precisely as possible.