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Virtual Consultation

Consult with California Surgical Institute in the Privacy of Your Home!

Step 1: Fill out the short form below. If you'd like, include 4 "before" photos to be evaluated by the doctors.

Step 2: Download, print and fill out our four Patient Information forms.

Step 3: Fax or mail your completed forms to our office.

Step 1 of 2

Required fields are marked with an asterisk *.

Title
Your First Name *
Your Last Name *
Age:
Gender:
Email: *
Day Phone:
Areas of Concern:
What Procedures are you interested in?
When are you hoping to have this procedure done?
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If you have some photos of yourself that you would like to share, please use the upload button below to send them to us. For best results:

1. Use a solid background.
2. Take one frontal photo with your body or face centered and facing forward.

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By checking this box you hereby agree to hold Marina Plastic Surgery Associates, its doctors and affiliates, harmless from any hacking or any other unauthorized use of your personal information by outside parties.