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7-3-3 Special with Dr. Nasseri

$7,000 for 1 PROCEDURE
$3,000 for the 2nd PROCEDURE
$3,000 for the 3rd PROCEDURE

ALL-INCLUSIVE CONCIERGE SERVICE:

HOTEL | RECOVERY ASSISTANT | TRANSPORTATION

Take advantage of this incredible promotion today!!!
Please answer the following questionnaire and submit your photos

Your surgeon will review your information and we will contact you with a personalized quote!
Select your preferred Surgeon*
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Date of Birth*

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Medical Questions
Current Weight*
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Desired Procedures*

Tummy TuckBBLBreastLiposuctionFace and NeckMale ProceduresHair TransplantVaginal RejuvenationInjectablesMedSpa ServicesMedical Weight LossOther
Please describe in detail what procedure you are interested in*
Your surgeon will give you a personalized recommendation based on your wishes
Have you had any previous cosmetic / plastic surgery?*

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Please describe your previous cosmetic / plastic surgery*
Do you have any medical conditions?*

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Select all the medical conditions you may have*

DiabetesHeart DiseaseThyroid DiseaseAsthma / BronchitisEmphysemaBreathing ProblemsAnesthesia ProblemsSevere AllergiesHigh Blood PressureClotting problemsStrokeLow Blood pressureCancerLiver ProblemsHepatitisEpilepsy / SeizuresDepression/AnxietyMental IllnessStomach ProblemsFluid RetentionMigraineArthritisFrequent Cold SoresHIVAnemiaKidney ProblemsOther
Please list all your "other" medical conditions*
Do you take any medications?*

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Include any herbal medicine, supplements, diet pills, vitamins, etc.
Have you lost more than 50 Lb?*

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Top Aesthetics takes privacy very seriously and complies with HIPAA policies whenever possible. We understand that communications today occur using many avenues of contact including email, text, phone call, web, social media, etc.; many of which are not HIPAA compliant. By selecting "I Agree" at the box on the top of this text I acknowledge, understand and accept that while using means of electronic communication my data transmission might not be fully compliant with all HIPAA regulations.
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