Cupid Lips® Plasma Plump Consultation Inquiry

Full name*

First NameLast Name
Phone number*
Please enter a valid phone number.Format: (000) 000-0000.
International Number

Country CodeArea CodeInternational Number
Email*
example@example.com
Preferred method of contact*
What is your DOB?*
Which treatment area are you interested in for the Cupid Lips® Plasma Plump Treatment?*
What improvements are you looking to make?*
How did you hear about us?*
Newsletter sign-up
Guidelines for required photos
High quality photographs with specific positioning are vital to making an accurate assessment and to optimize virtual consultations. Please include detailed photos by following the instructions below:
1. Photos must be recent and current within the past 7 days
2. Be sure your head is NOT turned on your body, we need "true" profile/side views
3. Do NOT take the photos from above or below or at an angle
4. Hold your device at arm's length, and look directly into the lens of the camera, NOT at the screen
5. Take photos in front of a solid background
6. Pull your hair back away completely from the face/ears
7. Please send FULL FACE photos - this is vital to providing an accurate assessment.
8. Remove glasses or any jewelry that might interfere or distract
9. Send full size, high-resolution images
Front view*

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Diagonal view*

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Front View of Slightly Open Mouth (No Smiling)

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Profile View of Slightly Open Mouth (No Smiling)

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Side view*

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After you submit the needed information, our office will review your information to see if we are able to help you in your journey with the services we provide. If you are a potential candidate, our office will contact you to arrange a virtual or in-office consultation with Dr Talei for facial procedures or Dr Cohen for Body procedures. A $500 consultation fee will be taken to make that appointment at that time. Lesser fees are available with our associates at Beverly Hills Center. For those who aren’t candidates, we are unable provide any analysis or recommendations. Any urgent medical needs should be directed to your primary care physician or nearby hospital.
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Guidelines for required photos