SCHEDULE A VISIT WITH ONE OF OUR SPECIALISTS

Please answer these questions if you are planning to have any type of breast surgery.

Did you breast feed?

Have you had any problems with your breasts (such as cysts, lumps, abnormal discharge, skin changes, etc)?

The last mammogram I had was:

What Bra size do you currently wear?

Do you plan on having children in the future?

Have any close relatives had breast cancer?

What type of implants are you interested in?

What cup size do you want to be after surgery (approximate)?