Online Photo Review

Online Photo Review

Use this form to submit your details, medical questionnaire and photos to obtain an estimate for a procedure. The form will take approximately 15 minutes to complete, and a payment of R750 by credit card will be required to submit the form.
Name*

First NameLast Name
ID or Passport Number*
Date of Birth*

DayMonthYear
Gender
Age*
Email Address*
example@example.com
Mobile Number*

Country Code
Do you live outside of Johannesburg?*

NoYes
Country of Residence*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
Where did you hear about Dr Doucas?

Select which types of anaesthetic you have previously had*

Local anaestheticSedationGeneral anaestheticNone
Which year was your last sedation or general anaesthetic?
Indicate any post operative complications
When would you ideally like to do the surgery?

Photographs

Photos are critical in determining if you are a good candidate for surgery. It is important that you upload good quality photos that adequately demonstrate the areas of concern.
Email
example@example.com
Below are some tips for providing good quality photos:
- Use good lighting
- Take photos against a solid colour (e.g. door or wall)
- The best quality photos are taken by another person
- Selfies often have poor angles, or do not adequately show the areas of concern
- Photos must be recent
Photo views to submit:
- Front view
- Side views - standing upright
- Side views - standing slightly bent forward (for abdominal areas of concern)
- Posterior / back
File Upload*

Cancelof

Terms and Conditions for Online Photo Review

1. Nature of the Service

This online service provides prospective patients with an indicative price estimate for plastic surgery based on photos and information they submit. It is intended for informational purposes only and is not a substitute for a comprehensive in-person consultation.

2. Non-Refundable Fee

The fee for this service is non-refundable, regardless of the outcome of the assessment, the accuracy of the information provided, or whether the procedure is ultimately scheduled or performed.

3. No Guarantee of Procedure

Receiving a price estimate does not guarantee that the procedure will go ahead. Final eligibility for surgery will be determined during a mandatory consultation, where your medical history, goals, and suitability for the procedure will be thoroughly evaluated.

4. Procedure Availability

Our service is limited to procedures we offer. We are not liable for providing estimates or advice on procedures outside of our scope of practice. If you are uncertain that we would be able to offer a procedure, enquire prior to submitting this form.

5. Accuracy of Information Provided

The price estimate is based on the photos and information you provide. Inaccurate, incomplete, or misleading submissions may result in an incorrect estimate. This estimate may be subject to change following a consultation.

6. Consultation Requirement

This service does not replace the need for a consultation. The final treatment plan, pricing, and any associated risks will be discussed and confirmed during the consultation with Dr Doucas.

7. No Medical Advice

This service does not constitute medical advice or establish a doctor-patient relationship. It is solely a preliminary assessment to provide an approximate cost for a potential procedure.

8. Confidentiality

We are committed to protecting your privacy. The photos and information submitted are used solely for the purpose of providing a price estimate and will be handled in accordance with applicable privacy laws and regulations, including the POPI & PAIA Acts.

9. Limitations of Liability

We are not responsible for:

Any decisions made based on the price estimate provided.
Changes in pricing following an in-person consultation.
Issues arising from procedures performed by other providers.

10. Acknowledgement and Acceptance

By using this service, you acknowledge and accept these terms and conditions in full.

For any questions or further information, please contact our office directly.
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Payment

Credit card details entered below are not retained and your card is charged immediately. The amount is non-refundable.
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Online Photo Review
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example@example.com
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Online Photo Review

Photographs

Terms and Conditions for Online Photo Review

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