Question #1

List in priority the things you would most like to improve about your image.

Question #2

Have you had any previous cosmetic surgery? (If no, go to question #6)

Question #3

What was the reason for your surgery?

Question #4

When was your last surgery performed?

Question #5

Who did your surgeries? (name the doctor and specialty)

Question #6

If you have not had another surgery, what are your realistic desires, i.e., what will/would it take for you to be satisfied with the outcome? Think about this and be honest.