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VIRTUAL

CONSULTATION

Please download the Patient Registration Form below, and fill out the form.  Submit the filled registration form, a copy of your Identification Card (Driver's License or Passport) and Photos via email at info@delacruzplasticsurgery.com.​

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  1.  Patient Registration Form

  2. Photograph Instructions for Patients

  3.  HIPAA Privacy Policy

PLEASE SEND US YOUR INFORMATION FOR VIRTUAL CONSULTATION

To register, please take the time to fill out the information below.

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