Request a consultation Step 1 of 10 10% Name(Required) First Last Phone(Required)Email(Required) Which procedures are you interested in?(Required) Surgical procedures Nonsurgical procedures such as laser procedures, fillers and injections, or aesthetician services Describe the results you would like to see after your procedure(s).(Required) Have you had a stroke?(Required) Yes No Have you had a heart attack or history of heart problems?(Required) Yes No Have you ever had a lung blood clot? Or other blood clot?(Required) Yes No Do you have a history of malignant hyperthermia or a family history of it?(Required) Yes No Do you have sickle cell anemia?(Required) Yes No You may not be a candidate for surgery at Alouf Aesthetics because of an answer you have provided. However, please complete the form and we'll reach out to you for more information. Let's keep going to complete your profile. Are you anemic?(Required) Yes No What was your hemoglobin count at your most recent blood test?Low hemoglobin can increase the risks associated with any surgery. Complications can include a higher risk of infection or a longer need for breathing assistance. We can discuss the specifics of your condition during your consultation. Are you a smoker?(Required) Yes No Smoking can cause breathing complications and difficulties with anesthesia, increase the risk of post-operative heart complications, and impair the healing process. You'll be required to stop smoking for at least 30 days and pass an oral nicotine test before surgery. Calculate your BMI using the tool above and enter the value below.(Required) Are you currently on a weight-loss plan?(Required) Yes No The closer you are to a healthy weight before surgery, the better your results will be. Are you diabetic?(Required) Yes No What was your most recent A1C result?NameThis field is for validation purposes and should be left unchanged. Δ
