Patient Photo Imaging Information Form

Aesthetic Plastic Surgery International
4216 King Street
King Street West Office Park
Alexandria, Virginia 22302

703•845•7400

For more information contact info@drgiunta.com

Cosmetic Surgery for Men and Women!

cosmetic surgery for men and women

Liposuction (Body Contouring)

Tummy Tuck

body

Photo Imaging Profile Information Form

Any information submitted via this form will not be used for any purpose other than to respond to your inquiry.

Instructions:

(1) Once you complete and submit this form

(2) you will receive an e-mail from us within a day or two instructing you how to attach your photo as a .jpg and a file size of 640x480

(3) Within 10 days of receiving your photo, you will receive both your 'before' and newly created 'after' image along with instructions about having your procedure scheduled if you choose to proceed

Name:
Email Address:
Street Address:
City:
State:
Zip Code:
Phone Number (optional):
If you would like to be contacted by phone, when is a good time to call?
Age:
Sex:
Height:
Weight:
Which procedure(s) are you interested in?
Breifly describe how we can help you:

For more information, contact: info@drgiunta.com

Cosmetic Surgery for Men Only!

male cosmetic surgery

NEW! Adult Stem Cell Breakthrough for Penis Girth Enlargement Patients.

Read about Dr. Giunta's NEW Free Fat Transfer Technique Using Platelet Rich Plasma

Free Fat Transfer (FFT) vs. Alloderm®

Phalloplasty Patient Satisfaction Survey

Male Enhancement

Phalloplasty (Penis Enlargement Surgery)

Penile Widening (Girth or Thickening)

Penis Lengthening

Before and After Photo Gallery

Testicular Implants

Scrotal Webbing (Turkey Neck)

Penis Enlargement Case History

Important Questions to Ask Before Choosing a Phalloplasty Surgeon

How Do I Begin The Process Of Making Phalloplasty Surgery Happen?

What to Expect After Phalloplasty Surgery

Post-Operative Penile Stretching

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