INNOVATIVE PLASTIC SURGERY CENTER INC.

Ask us questions, inquire about pricing, or request a consultation. We welcome all of your comments and suggestions as well. We also invite you to call and arrange a private consultation with Dr. Pollack.

Type of Appointment
Title & First Name
Middle initial
Last Name
Street address
Address (cont.)
City
State/Province
Zip/Postal code

Home phone
Work phone
Fax
E-mail
Contact me at
How did you find our website?
Referred By (Mrs. Doe)
Preferred Method of Contact	mail phone e-mail

Please select a Service that you are interested in (check all that apply):
Facelift and/or Necklift		Forehead Lift
Neck Liposuction		Rhinoplasty (Nose Reshaping)
Eyelid Surgery		Chin Implant
Otoplasty (Ear Pinning)		Breast Reduction
Breast Augmentation		Breast Lift
Liposuction		Tummy Tuck
Arm Lift		Plastic Surgery After Weight Loss
Laser Skin Resurfacing		Laser Hair Removal
Restylane		Botox Cosmetic
Skin Care Line		Schedule a Consultation
Financing Options
Other (please specify in area below)
Please enter any additional questions you may have:


Your privacy is important to us. We will never sell, barter or rent your personal information or email address to any unauthorized third party.