Patient Details

Identification & contact information

Patient Name (first & last)
Date of Birth (DD/MM/YY)
Email Address
Consultation Form
1 of 5
Recipient Regions

Draw the recipient regions on the patient.
Label each in order to reference graft volume below.

Regions & Graft volume:
Consultation Form
2 of 5
Photograph Patient

Take 4 images of the angles highlighted below.

Consultation Form
3 of 5
Send Images

Please send the images to the patient folder

Consultation Form
4 of 5
Confirm Submission.

Once submitted, we will begin rendering the patient simulation.

Consultation Form
5 of 5
Form submitted
Oops! Something went wrong while submitting the form