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VIRTUAL CONSULTATION

In Scottsdale, AZ

Virtual Consultations are a great option for out-of-town patients who want to consult with Dr. Ghafouri and discuss options.

If you would like to schedule a virtual consultation with Dr. Ghafouri, simply fill out the form below to submit your information and photos to Dr. Ghafouri who will take a look to determine if you would be a good candidate for a procedure.

*Form terms*: Communications through our website or via email are not encrypted and are not necessarily secure. Use of the internet or email to communicate with Arizona Oculoplastic Specialists 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 Arizona Oculoplastic Specialists, its doctors, affiliates and vendors, harmless from any hacking or any other unauthorized use of your personal information by outside parties.

VIRTUAL CONSULTATION REQUEST FORM

Take at least 1 photo of each area and attach the photos below.

  • Only take selfies for face procedures
  • Have someone else take the photo or use a mirror for breast or body procedures
  • For face procedures, only include a picture of your face. For neck procedures please point chin down to chest for all angles
  • For body or breast procedures, you do not need to include your face

Patient Information

MM slash DD slash YYYY

PROCEDURE OF INTEREST (CHECK ALL THAT APPLY)

EYELID SURGERY
FACIAL PLASTIC SURGERY
RECONSTRUCTIVE SURGERY
MEDSPA MD

ATTACH PHOTOS (EXAMPLE BELOW)

Max. file size: 50 MB.
Max. file size: 50 MB.
Max. file size: 50 MB.

TELL US MORE

Please include information regarding any medical conditions, allergies to medications, current medications, previous procedures (include month/year of surgery) and history of weight gain or loss.

EXCELLENCE-DRIVEN,
SURGICAL EXPERTISE.

View before & After Gallery

What procedure are you interested in?