Thank you for your interest in starting your surgical journey with us. Submitting this form allows Dr. Miotto to review your medical information and determine whether surgery is a safe and appropriate option to help you achieve your goals. There is no charge to submit this form.
After submission, our coordinators will reach out to guide you through the next steps and answer any questions you may have. Your formal consultation with Dr. Miotto has a $500 consultation fee, which will be fully credited toward your surgical procedure once surgery is booked.
*Please submit 3 clear, facial photographs in JPG or PNG format with the total file size under 5MB.
