Contact the Beverly Hills Rhinoplasty Surgeon



Contact me by (check all that apply):
Phone	E-mail

I have been considering a procedure (check only one):

Less than one month.	Between one & six months.	Longer than six months.

Contact information:

First name: *
Last name: *
Sex:	Male Female
D.O.B.:	Month: Day: Year:
Address:
City:
Zip Code:
Best phone # to reach you: *
Best time to call: *	Morning Mid-day Afternoon
	Evening Other:
E-mail: *

If you are interested in a personal consultation, please call our office to set up an appointment with one of our doctors and Jade Gerad, our patient care coordinator at (310) 275-2467.

When? (check only one)

I'm likely to have this procedure sometime in the next year.

I'd really like to get this done in the next 4 months.

I'd consider coming in for a personal consultation.

I'd like to set up a consultation soon.

Have you had a previous rhinoplasty(ies)? If so, please explain in chronological order a brief description of what was performed.

Was a septoplasty for correction of a deviated septum performed? Yes No

Have ear and/or rib cartilage been used? If so, which side?

Have fascia from your scalp been used? If so, which side?

Are there any implants in your nose? if yes, need a description of what type.

Do you have nasal obstruction? If so, which side?

If you do not have this information, please request the operative report(s) from the previous surgeons and fax prior to your appointment or bring them into our office at your consultation.

Comment/Question:

If you have photos of yourself that you would like to send us, please use the upload buttons below to upload photos:

Frontal Photo:

Base Photo:
up the nose view

Oblique Right Photo:

Oblique Left Photo:

Profile Right Photo:

Profile Left Photo:

Please list any previous surgeries:

Thank you!