Alfred Sofer, MD, FACS
Diplomate of the American Board of Plastic & Reconstructive Surgery
Patient Evaluation Form
In order to serve you more expediently, we ask you to fill out this evaluation form. Dr. Sofer will review the information you provide a preliminary assessment and determine the best surgical option for you. You will receive a response from someone from our staff within 48 hrs. Please note that this assessment is only preliminary and an in person consultation needs to be completed before the actual surgery.
How Did You Hear About Us
Street Address Line 2
State / Province
Postal / Zip Code
Date of Birth
Procedure of Interest (select all that apply)
Breast Augmentation (enlargement)
Brazilian Butt lift (BBL, Fat transfer to the buttocks)
Abdominoplasty (tummy tuck)
Blepheroplasty (eyelid surgery)
Past Medical History (please type NONE if no medical issues)
Past Surgical History (please type NONE if not past surgeries)
Allergies (please type NONE if no Allergies)
Medications (please type NONE if you’re taking no medications)
Do You smoke?
Number of children (please type 0 if no children)
Frontal View image
Please upload a frontal view of the area You’d like to enhance. DO NOT INCLUDE YOUR FACE.
Side view image 1
Please upload a right side view of the area You’d like to enhance. DO NOT INCLUDE YOUR FACE. ase upload
Side view image 2
Please upload a left side view of the area You’d like to enhance. DO NOT INCLUDE YOUR FACE.
Are you interested in the Miami or Connecticut location? (Tummy tuck is not offered in CT at this time)
CT (near NYC)
Would you be interested in the CT location for a more personalized experience?
Should be Empty: