Pre-Consultation Questionnaire

Tummy Tuck Questionnaire

Please help us prepare for your upcoming tummy tuck consultation by answering a few questions ahead of time.

First Name *

Last Name *

Email *

Birthdate

Phone

Patient Type

What is your current height and weight?

What is your current BMI?

Do you smoke/use tobacco, marijuana, or vape?

Who referred you to Dr. Piazza?

What are your current concerns about your abdomen? *

Have you had tummy surgery before?

If so, what kind?

Do you have children? If yes, how many?

Did you deliver vaginally or by C-section?

What are you looking for in results? *

Do you have any current medical issues we need to be aware of? (Thyroid, High Blood Pressure, Diabetes)

By submitting this form, you agree to be contacted by phone, email, or text, and that any associated call may be recorded for quality and training purposes.

Tummy Tuck Questionnaire

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