Intake

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Thanks in advance for completing this health intake, which I kindly request for all patients seeking consultations with me. It will take about 5 minutes. This form is HIPAA compliant and confidential.
My Goals Are...*
Let us know your concerns here... We're listening!
Procedure*
Please select your main procedure of interest
I'd like to schedule my treatment by:
When are you looking to have this done?
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Date of Birth*

MoDayYear
Height and Weight:*
Are you trying to lose weight before your procedure?*
For safety reasons we do not perform general anesthesia on patients with a BMI over 30.
Signature*

Clear
Do you have any children?*
How many?*
Did you have any by c-section?*
How recently did you deliver?*
It’s safest to wait 12 months after childbirth to have most procedures.
Did you breastfeed?*
How recently?*
When was the last time you smoked or vaped?*
Smoking can interfere with healing after surgery.
Have you had any surgeries before?*
What was it?
(type of surgery)
How recently was this?*
Do you have a history of blood clots/DVT?*
Do you have any medical issues?*
Please tell us about your medical history:*
If you take steroids, have anemia, or a history of blood clots, please let us know.
Do you take any medications?*
Please list your medications:*
You don't need to include dosing. Just the drug names, please.
Do you have any allergies?*
Please list your allergies:*
Are you currently working? *
What do you do for work?*
This helps us guide you through your recovery.
Do you live in Florida?*
Are you interested in staying at our Guest House?*
How did you hear about Dr. Opp?*
Think about the first place you saw us!
If you’d be so kind, please share their name:*
Friends: the spice of life.
Do you want financing information?*
Photos are required to schedule your consult online and for in-person consults:*
Upload ID and Photo(s)

While deeply personal, photos are required for most appointments. They are necessary for any virtual consultations and allow us to formulate a treatment plan and quickly get you on the schedule.
Driver's License

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Your driver's license or other form of photo ID Cancelof
Photo 1*

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Please attach a photo that best shows your area of concern. Cancelof
Photo 2

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Additional photos help us to understand your goals. Cancelof
Photo 3

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Thank you for your trust! Cancelof
Optional Photo 1

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Photos are optional for labiaplasty consults. While helpful, this is not required. Cancelof
Optional Photo 2

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Photos are optional for labiaplasty consults. Cancelof
Because of file size and HIPAA security, photos can take up to 30 seconds to upload. Please be patient, your photos will go through securely! You can also select a smaller file size for faster uploads.
Should be Empty:

Next Steps…

Upload ID and Photo(s)