Virtual Consultation Form

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Personal Information

Your personal information will not be shared with, or sold to, anyone outside of our organization for any reason.

    Title:

    Gender:

      

      

    What type of results are you hoping to achieve?

    More AthleticYoungerHealthierCosmetic Correction

    When are you hoping to have this procedure done?

    Is there an event that is motivating you?

    Have you had cosmetic surgery before? YesNo

    How would you like us to reply? EmailPhone

    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 Dr. Sampson to make the most comprehensive assessment.

    1. Use a solid background.
    2. Take one frontal photo with the face centered and looking straight.
    3. Take at least one, preferably two profile photos.
    Example of a good photo
    Example frontal view.
    Example of a good photo
    Example profile view.

    Photo 1: Photo 2:

    Photo 3: Photo 4:


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      Argyle Plastic & Reconstructive Surgery

      DR. JOHN SAMPSON, M.D.
      Board Certified Plastic Surgeon

      1514 Fourth Street
      Jackson, MI 49203

      (517) 780-0080

      Schedule an Appointment