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	<title>Ivan Thomas M.D. Blog.com &#187; Request a Complimentary Consultation</title>
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	<description>Frequently asked questions about plastic surgery.</description>
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		<title>Request a Free Consultation with a Plastic Surgeon</title>
		<link>http://www.ivanthomasmdblog.com/2009/12/request-a-complimentary-plastic-surgery-consultation/</link>
		<comments>http://www.ivanthomasmdblog.com/2009/12/request-a-complimentary-plastic-surgery-consultation/#comments</comments>
		<pubDate>Wed, 16 Dec 2009 17:56:56 +0000</pubDate>
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				<category><![CDATA[Request a Complimentary Consultation]]></category>
		<category><![CDATA[Beverly Hills Plastic Surgery]]></category>
		<category><![CDATA[Coplimentary Plastic Surgery Consulation]]></category>
		<category><![CDATA[Plastic Surgery Beverly Hills]]></category>

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I would like a FREE consultation with a Plastic Surgeon!

        

Request A Consultation
To request a consultation for a specific procedure, or if you have any questions or comments, please fill out the form below:
        








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</strong><br />
<strong>I would like a FREE consultation with a Plastic Surgeon!</strong></p>
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<div class="FullContent">
<h1>Request A Consultation</h1>
<p>To request a consultation for a specific procedure, or if you have any questions or comments, please fill out the form below:</p>
<p>        <img src="images/Doc_Photo_Consul.jpg" alt="Dr. Thomas" class="ImgR" /></p>
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<table width="580" border="0" cellspacing="0" cellpadding="1" align="center">
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<td colspan="3"><span style="font-size:11px;">*** All information provided will be confidential and not shared with any other sources. ***</span></b></p>
<p>                          <B><I>Fields marked with<br />
                            an &quot; <font color="#FF0000">*</font> &quot; are<br />
                          required.</I></B></td>
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<tr class="maintext">
<td width="183" valign="top">&nbsp;</td>
<td colspan="2" valign="top">&nbsp;</td>
</tr>
<tr class="maintext">
<td colspan="3"><strong>I would like my procedure:<br />
                            (check only one): </strong></td>
</tr>
<tr class="maintext">
<td width="183">
<div align="center">
<input type="radio" name="Considering_A_Procedure" value="In the next 4 months">
                              <font size="2" face="Arial, Arial, Helvetica, sans-serif" color="#000000"></p>
<p>                              </font>Blog &#8211; In the next 4 months.</div>
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<td width="236">
<div align="center">
<input type="radio" name="Considering_A_Procedure" value="Sometime in the next year">
                              <font face="Arial, Arial, Helvetica, sans-serif"><font size="2"><br />
                              </font></font>Blog &#8211; Sometime in the next year.</div>
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</tr>
<tr class="maintext">
<td width="183">&nbsp;</td>
<td width="236">&nbsp;</td>
<td width="189">&nbsp;</td>
</tr>
<tr class="maintext">
<td colspan="3"><strong>Contact Information:</strong></td>
</tr>
</table>
<table width="440" border="0" cellspacing="5" cellpadding="1" align="center">
<tr class="maintext">
<td width="250">
<div align="left">First name:<font color="#FF0000"><br />
                              *</font></div>
</td>
<td width="335">
<input name="First_Name" type="text" id="First_Name" size="20" maxlength="20">                          </td>
</tr>
<tr class="maintext">
<td width="250">
<div align="left">Last name:<font color="#FF0000"><br />
                              *</font></div>
</td>
<td width="335">
<input name="Last_Name" type="text" id="Last_Name" size="20" maxlength="20">                          </td>
</tr>
<tr class="maintext">
<td width="250">
<div align="left">Address:<font color="#FF0000"><br />
                              *</font></div>
</td>
<td width="335">
<input name="Address" type="text" id="Address" size="30" maxlength="30">                          </td>
</tr>
<tr class="maintext">
<td width="250">
<div align="left">City:<font color="#FF0000"><br />
                              *</font></div>
</td>
<td width="335">
<input name="City" type="text" id="City" size="20" maxlength="20">                          </td>
</tr>
<tr class="maintext">
<td width="250">
<div align="left">State:<font color="#FF0000"><br />
                              *</font></div>
</td>
<td width="335">
<select name="State" size="1">
                              <option>Choose a state</option></p>
<p>                              <option value="AL">Alabama</option><br />
                              <option value="AK">Alaska </option><br />
                              <option value="AR">Arkansas </option><br />
                              <option value="AZ">Arizona</option><br />
                              <option value="CA">California </option><br />
                              <option value="CO">Colorado</option></p>
<p>                              <option value="CT">Connecticut</option><br />
                              <option value="DE">Delaware</option><br />
                              <option value="DC">District of Colombia</option><br />
                              <option value="FL">Florida</option><br />
                              <option value="GA">Georgia</option><br />
                              <option value="HI">Hawaii</option></p>
<p>                              <option value="ID">Idaho</option><br />
                              <option value="IL">Illinois</option><br />
                              <option value="IN">Indiana</option><br />
                              <option value="IA">Iowa</option><br />
                              <option value="KS">Kansas</option><br />
                              <option value="KY">Kentucky</option></p>
<p>                              <option value="LA">Louisiana</option><br />
                              <option value="ME">Maine</option><br />
                              <option value="MD">Maryland</option><br />
                              <option value="MA">Massachusetts</option><br />
                              <option value="MI">Michigan</option><br />
                              <option value="MN">Minnesota </option></p>
<p>                              <option value="MS">Mississippi</option><br />
                              <option value="MO">Missouri</option><br />
                              <option value="MT">Montana</option><br />
                              <option value="NE">Nebraska</option><br />
                              <option value="NV">Nevada</option><br />
                              <option value="NH">New Hampshire</option></p>
<p>                              <option value="NJ">New Jersey</option><br />
                              <option value="NM">New Mexico</option><br />
                              <option value="NY">New York</option><br />
                              <option value="NC">North Carolina</option><br />
                              <option value="ND">North Dakota</option><br />
                              <option value="OH">Ohio</option></p>
<p>                              <option value="OK">Oklahoma</option><br />
                              <option value="OR">Oregon</option><br />
                              <option value="PA">Pennsylvania</option><br />
                              <option value="PR">Puerto Rico</option><br />
                              <option value="RI">Rhode Island</option><br />
                              <option value="SC">South Carolina</option></p>
<p>                              <option value="SD">South Dakota</option><br />
                              <option value="TN">Tennessee</option><br />
                              <option value="TX">Texas</option><br />
                              <option value="UT">Utah</option><br />
                              <option value="VT">Vermont</option><br />
                              <option value="VA">Virginia</option></p>
<p>                              <option value="WA">Washington</option><br />
                              <option value="WV">West Virginia</option><br />
                              <option value="WI">Wisconsin</option><br />
                              <option value="WY">Wyoming</option><br />
                            </select>
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</tr>
<tr class="maintext">
<td width="250">
<div align="left">Zip code:<font color="#FF0000"><br />
                              *</font></div>
</td>
<td width="335">
<input name="Zip_Code" type="text" id="Zip_Code" size="5" maxlength="5">                          </td>
</tr>
<tr class="maintext">
<td width="250">
<div align="left">Phone:<font color="#FF0000">* </font></div>
</td>
<td width="335">
<input name="Phone" type="text" id="Phone" size="20" maxlength="20">                          </td>
</tr>
<tr class="maintext">
<td width="250">
<div align="left">E-mail:<font color="#FF0000"><br />
                              *</font></div>
</td>
<td width="335">
<input name="Email" type="text" id="Email" size="20" maxlength="30">                          </td>
</tr>
<tr class="maintext">
<td width="250">
<div align="left">Procedure: <font color="#FF0000">* </font></div>
</td>
<td width="335">
<select name="Procedure_Of_Interest" size="1">
                              <option>Choose a Procedure</option><br />
							  <option></option><br />
							  <option>&#8211;FACE&#8211;</option></p>
<p>							  <option value="Nose Surgery">Nose Surgery</option><br />
                              <option value="Exoderm Peel &#038; Lift">Exoderm Peel &#038; Lift</option><br />
                              <option value="Face Lift">Face Lift</option><br />
                              <option value="Eyelids">Eyelids</option><br />
                              <option value="Ears">Ears</option><br />
                              <option value="Botox Injections">Botox Injections</option></p>
<p>							  <option></option><br />
							  <option>&#8211;BODY&#8211;</option><br />
                              <option value="Tummy Tuck">Tummy Tuck</option><br />
                              <option value="Body Sculpting">Body Sculpting</option><br />
                              <option value="Liposuction">Liposuction</option><br />
                              <option value="Arm Lift">Arm Lift</option></p>
<p>							  <option></option><br />
							  <option>&#8211;BREAST&#8211;</option><br />
							  <option value="Breast Augmentation">Breast Augmentation</option><br />
                              <option value="Breast Lift">Breast Lift</option><br />
                              <option value="Breast Reduction">Breast Reduction</option><br />
                              <option value="Nipple Size Reduction">Nipple Size Reduction</option></p>
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<td width="250" valign="top">
<div align="left">Questions/Comments:                            </div>
</td>
<td width="335">
                            <textarea name="Comments" cols="30" rows="5"></textarea>                          </td>
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<input type="radio" name="Financing" value="I would like information about financing"> Yes &nbsp; | &nbsp;<br />
<input type="radio" name="Financing" value="I would not like information about financing"> No<br />
                          </strong></td>
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