Consultant Form - Cosmetic Surgery Advancements

Please complete the form below to apply for membership.

Name(Required)

First Last

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

What regulatory medical body in your country of residence are you registered with?(Required)

Have you been registered for at least 5 years?(Required)

Yes

No

Are you currently in good medical standing (not restricted or suspended)?(Required)

Yes

No

What plastic surgery association or society do you hold an active membership with?(Required)

What are your areas of specialty and are there any specific techniques you use?(Required)

If you provide breast surgery with implants would you recommend saline or silicone filled breast implants?(Required)

If you provide breast surgery with implants which manufacturers do you use and why?(Required)

If you provide breast surgery with implants what type of implant placement do you perform most often and why?(Required)

If you provide breast surgery with implants what type of incision do you perform most often and why?(Required)

If you provide body contouring, which type of liposuction technique do you perform most often and why?(Required)

If you provide rhinoplasty which type of surgical technique do you perform most often and why?(Required)

If you provide face rejuvination surgery which type of surgical techniques do you perform most often and why?(Required)

I declare that the information provided is accurate. Type name to confirm as signature:(Required)

Date

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