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 Rejuvalife Vitality Institute 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 Rejuvalife Vitality Institute, 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