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Print Friendly VersionYour 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:
Your First Name: *
Your Last Name: *
Age:
Gender:
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?

Is there an event that is motivating you?

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.
  1. Use a solid background.
  2. Take one frontal photo with the body centered and facing forward.
  3. Take at least one, preferably two profile photos.
Example of a good photo
Example frontal view.
Example of a good photo
Example frontal view.
Example of a good photo
Example side view.
Example of a good photo
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: Use this image to validate this form.
Enter Code: *


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Communications through our website or via email are not encrypted and are not necessarily secure. Use of the internet or email is for your convenience only, and by using them, you assume the risk of unauthorized use.

By checking this box you hereby agree to hold Marina Plastic Surgery Associates, its doctors and affiliates, harmless from any hacking or any other unauthorized use of your personal information by outside parties.



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