Cosmetic Gynecology Dallas Online Phone Consultation

  • Women's HEALTH

  • ONLINE CONSULTATION FORM

  • Thank you for your interest in Cosmetic Gynecology of Dallas. We understand that expertise is a key concern when considering your procedure. This online consultation form will allow you to safely and securely send pictures of the area(s) of concern. This form is HIPAA Compliant, and data is encrypted, so your privacy is not compromised.

    After filling out the questionnaire, please follow the directions below if you would like to securely submit your photos for review by Dr. Nathan Thomas

    1. Turn your camera to forward-facing view

    2. Set camera timer to 3 seconds or 10 seconds

    3. Take 2 pictures while on your back with your legs open (as if you were on an exam table) 4. Take 1 picture in your normal standing position *It is important not to pull or distort your skin*

  • Date of Birth*
     / /
  • Format: (000) 000-0000.

  • Please select the procedure you are interested in having done, then answer the related questions.

  • LABIAPLASTY
  • Do they cause you discomfort?*
  • Are you self-conscious?*
  • Does it cause an altered appearance in tight clothing?*
  • (For Labia Minora Only) Do you want to reduce the size of your Clitoral Hood as well?*
  • VAGINAL REJUVENATION
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof

  • , certify that I am 18 years of age or older, and understand that I am submitting these photos of my own accord, soley for the purpose of medical

  • Date*
     / /
  •  
  • Should be Empty: