The Center for Plastic Surgery & Med Spa
Sandra Bouzaglou, MD, FACS
The Science of Medicine & Art of Beauty

Online Consultation Form

If you are considering plastic surgery but are outside of the local area or cannot find the time in your busy schedule to come in to the office for a personal consultation, our online consultation is a convenient way to determine your candidacy and get a better sense of your treatment options. 

If you desire an online consultation simply download the form, fill it out completely and return it to us via fax (859) 263-9160 or postal service. One of our staff members will contact you.  Dr. Bouzaglou will then review the form and respond by either email or phone.  She will discuss the required photos that you will need to fax and any questions that you may have.  You may also desire to schedule an in-office visit with Dr. Bouzaglou, as part of your consultation. 

The cost for an "on-line" consultation is $200.00. This fee includes all communication between you and Dr. Bouzaglou, as well as a personal in-office visit if you should so desire.  This ENTIRE amount is credited towards the cost of your procedure.   

We look forward to hearing from you!

Please download the form below, complete, and fax back to our office at (859) 263-9160.

Download Consultation Form

 This web site uses files in Adobe Acrobat Portable Document Format  (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.

Contact Us

We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form below.


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