DR. MIAMI SINGLES RESERVATION
Fill out this information to book your mommy makeover!
Choose the date you would like to have surgery-- we will try our best to accommodate you :)
Name
*
E-mail
*
Phone Number
*
Choose your single:
*
Breast Augmentation: $7145
Nose Job: $8245
Tummy Tuck: $10,145
Breast Lift: $10,895
Lipo 360: $11,195
BBL: $15,545
Other
Please enter your height & weight
*
Birthday
*
-
Month
-
Day
Year
Date
Do you smoke?
*
Yes
No
Are you diabetic?
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Yes
No
Have you or any family member ever had a blood clot in your legs (DVT) ?
*
Yes
No
Do you need financing for surgery?
*
Yes
No
Submit a photo of your FRONT side
*
Browse Files
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of
Submit a photo of your BACK side
*
Browse Files
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of
Are you ready to leave your $500 deposit for surgery:
*
YES
NO
Submit
Should be Empty: