Dallas Rhinoplasty Specialist

& Create A New Reality

Internet Consultation

Step 1: Completely Fill out the Form at the Bottom of this Page.

Step 2: Take the Photos

Have the six(6) required pre-operative photos taken as depicted below. The photo set should include two(2) side views, two(2) three-quarter views, one(1) forward facing, and one(1) with the area of the head tilted back. Please view the examples below as reference.

Example

Example

In order for Dr. Cochran to adequately assess your candidacy, the photos must be taken in good lighting against a solid-colored background. There should be no shadows on the face. You can take the photos at home, using any camera with a zoom lens, by fully zooming in on the face. However, ordinary point-and-shoot cameras are not recommended because they distort the image too much for the resulting photos to be helpful. You may also have the pictures taken at any portrait studio.

Step 3: Submit the Forms, Photos, and Fee

Gather:

  • All completed forms
  • All requested photos
  • $200 consultation fee (You can pay this fee by either calling the office with your credit card information or mailing a check to the address below made out to the Dallas Rhinoplasty Center. This consultation fee will be applied to the surgery payment if you are a good candidate; if not, it will be returned)

e-mail the forms and photos to:
Mayra@dallas-rhinoplasty.com

Or send them via U.S. mail, FedEx, or UPS to:

Dallas Rhinoplasty Center
8144 Walnut Hill Ln., Suite 170
Dallas, TX 75231
Phone: 214.369.8123
Fax: 214.369.2984

Step 4: Hear Back From Us

Our office will contact you via e-mail with the results of your screening.

6. If you have nasal breathing problems (if not, go to question #7)
**Please answer (n/a) if not applicable

d. Please estimate the percentage you feel your breathing is decreased in each nostril.
(Example: 100% = completely blocked, 50% = getting half the air you think you should, etc.)

Medical History

Do you or have you ever had any of the following?

Bleeding/Scarring/Anesthesia:

Personal History

**If you have a history of cocaine use, you must provide clearance from an ENT doctor stating that you have no septal perforation, infection or damage to the internal lining of your nose.

Terms of Use
Terms of Use of Website and Electronic Communications Communications through our website, contact forms or via email are not encrypted and are not necessarily secure. Use of the internet or email is for your convenience only, and by using them, you assume the risk of unauthorized use. Using this site and its contact forms, you hereby agree to hold Dr. Cochran & The Dallas Rhinoplasty Center, its doctors, employees and affiliates, harmless from any hacking or any other unauthorized use of your personal information to or by outside parties. Any e-mail messages submitted or generated from use of this site and its forms and any documents subsequently attached to messages are confidential and may contain information that is protected from disclosure by various federal and state laws, including the HIPAA privacy rule (45 C.F.R., Part 164). This information is intended to be used solely by the entity or individual to whom this message is addressed. If you are not the intended recipient of emails or electronic communications generated by use of this site, be advised that any use, dissemination, forwarding, printing, or copying of any message without the sender's written permission is strictly prohibited and may be unlawful. Accordingly, if you receive any message in error, please notify the sender immediately by return e-mail or call 214.369.8123, and then delete such message.