Virtual Consultation Form
Thank you for your interest in Tampa Bay Body Sculpting, a world renowned Liposuction & Body Contouring clinic with over 20,000+ procedures, Dr. Robert Miles can get you to your body goals!We are happy to set up a surgical plan that fits your goals! All consultations are virtual at this time. We are happy to schedule a tele-consultation or an in office consultation after we receive your information. To begin your Virtual Consultation please reply with the following:
Name
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First Name
Last Name
Date of Birth
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Month
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Day
Year
Date
Email
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example@example.com
Phone Number
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Please enter a valid phone number.
Height
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ex. 5'0"
Weight
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Please upload photos of the area(s) for surgery: front, side, and back (in a 2 piece)
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Procedure(s) you are interested in, check all that apply:
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The Triple Crown Collection: Lipo360+BBL+The Signature Waist
Liposuction
Body Contouring
Brazilian Butt Lift (BBL)
Chin Liposuction
Chest Reduction/Gynecomastia
Abdominal Sculpting (6 Pack Abs)
Arm Liposuction
Thigh Liposuction
Liposuction for Lipedema
Breast Rejuvenation (Fat Transfer to Breasts)
Other
Have you had Cosmetic Surgery before? If so, please include what procedure you have had including area(s) for surgery, date(s) of procedure, and Dr. who performed the procedure:
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List any Medical Conditions:
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Are you allergic to any medication(s)? If so, please list.
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No
Yes
Do you have any allergies including environmental and/or food allergies?
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No
Yes
Please list all medications you are currently taking
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Do you smoke, drink, or do any drugs?
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Do you have current labs (Complete Metabolic Panel) within 3 months?
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Yes
No
Wish date for surgery
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-
Month
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Day
Year
Date
By submitting this form to Tampa Bay Body Sculpting, I consent to receive communications from this company via methods including, but not limited to, phone calls, text messages, emails, or other forms of contact as necessary.
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How did you hear about us?
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referral: friend
I am a previous patient of Dr. Miles
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Your location (City, State)
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