What is your height? *

What is your current weight? *

Height and weight are used to determine your BMI (Body Mass Index). Dr. Mehta typically requests a BMI around 30 or below prior to most elective cosmetic surgeries.

Do you currently smoke or vape? *

Depending upon the cosmetic procedures you have done, you may be required to cease smoking or vaping prior to and after surgery for a specific timeframe.

Are you currently taking a GLP-1 medication (such as Ozempic, Wegovy, or Mounjaro)? *

What’s your main goal with plastic surgery? *

Which Service Are You Interested In? *

Cosmetic surgery is considered elective, which means insurance does not cover it. Are you comfortable paying out-of-pocket for your cosmetic procedure? *

To reserve your consultation with Dr. Chirag Mehta, we require a $100 scheduling deposit. This amount will go toward your plastic surgery if you choose to move forward. Are you able to place this deposit at the time of booking? *

First Name *

Last Name *

Email *

Phone *