Your Virtual Consultation

Consult with Marina Plastic Surgery in the Privacy of Your Home!

So many of our patients fly in from across the country and around the world that we've developed the Virtual Consultation. The virtual consultation allows you to share information about your current condition and desired surgical outcomes with Dr. Stevens and Dr. Stoker, before you fly to Los Angeles for surgery.

If you are interested in a preliminary, complimentary evaluation in the privacy of your own home or simply have a question - fill out this form.

Required fields are marked with an asterisk *.

Title: Select One Mr. Mrs. Ms. Dr.
Your First Name: *	Your Last Name: *
Age:	Gender: ---- Female Male
Email: *	Day Phone: *
Height:	Weight:
Measurements:
Areas of Concern:
What type of results are you hoping to achieve?
More Athletic Younger	Healthier Cosmetic Correction
Other notes:
When are you hoping to have this procedure done? Please select a time frame: Within 1 Month 1-2 Months 3-6 Months 6 Months or more
Is there an event that is motivating you? Please select an event: Wedding Class Reunion Birthday Family Reunion None of these
Have you had cosmetic surgery before? Yes No If yes, please indicate surgical procedures:
How would you like us to reply? Email Phone
If you have some photos of yourself that you would like to share, please use the upload button below to upload photos to send to us: To make the most out of your virtual consultation, do your best to submit your photographs in the following format. This will allow the doctors to make the most comprehensive assessment. Use a solid background. Take one frontal photo with the body centered and facing forward. Take at least one, preferably two profile photos. Example frontal view. Example frontal view. Example side view. Example side view. Photo 1: Photo 2: Photo 3: Photo 4:

To discourage SPAM, we ask that you type your code (displayed below) in the text box.

Your Code:
Enter Code:	*

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