Contact Dr. Lazarus - Dr Dirk Lazarus Plastic Surgeon

Name:*

First Last

Email:*

Instructions:

Please answer ALL the following questions.

What is the nature of your problem(s) or the possible procedure(s) that you are enquiring about?*

Note: I am limited in the opinion that I can give based purely on email correspondence with your information and photos, and any opinion should not be construed as medical advice. Medical advice can only ever be given at a proper consultation

Please give me full details of why you are contacting me:*

Please tell me the nature of your problem or the possible procedures you might be interested in (if you know that). Give me as much background as possible. For example, for breast surgery I need to know the issue and what you are thinking of in terms of surgery. I need to know your bra size, your desired bra size, pregnancy and breast feeding history, past or family breast problems such as breast cancer, etc. Mamogram results? Any previous surgery to the area?

The reason(s) you are contacting me*

I want your opinion (see note above about medical opinion via email). Without photos, I cannot give any opinion as I need to see the issue.
I have read your site, but I still have some questions. You can enter these below. Please type your questions for me.
I want to make a booking. For bookings, don't send this form, please contact Anneli@plasticsurgery.co.za directly.
I want to make a price enquiry. For price enquiries, do not send me this form. Just send an email to info@plasticsurgery.co.za to receive my price list.
Other

Your questions/other

Age:*

Sex:*

Male
Female

Weight (kg):*

Height (cm):*

Country of current residence:*

City of current residence:*

List any chronic medical problems you have:

List any chronic medication you take:

List any previous surgery you have had:

If you have had previous plastic surgery and your enquiry concerns that, then I need full details of that surgery: when, what, by whom, implant type, size, placement (if applicable) - the more details the better.

List any allergies you have:

How many cigarettes do you smoke per day?*

Upload images below and then submit:

For any facial work I need 5 photographs of your face taken with the camera at eye level and from about 2-‐3 meters away. These portraits should be with you face in repose (not smiling), relaxed, eyes open. The photos should include your whole face and neck. I need the following views: front, each side and each ¾ view. Further views or close ups of problems can be included.

For breast surgery photographs are useful but I frequently cannot make a full judgment on photos alone as I need to measure the breasts and examine them too. Nevertheless I can sometimes comment or make suggestions. As for facial work I need 5 views. Hands should be at your side for the frontal view and behind your back for the other views.

For body work I need to see from your breasts to below your knees. You can wear underwear or a bikini for these photos. For body views I like 8 photographs: front, back, each side and each ¾ view (front left, front right, back left, back right). For tummies I need the same 8 photographs from your breasts down to your groin (you can exclude your thighs).

Drop files here or