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Internet Consultation

An Internet Consultation is a pre-appointment evaluation to assess if you are a good rhinoplasty candidate prior to having an in-person appointment with Dr. Cochran. Based on photos and a questionnaire you submit securely below, Dr. Cochran will assess your specific needs, determine if your goals are realistic, and assess if you are a good rhinoplasty candidate. After reviewing your information, Dr. Cochran will respond with a written report via email with his impressions and suggestions for a custom approach to achieve your goals, as well as provide you with an estimate of the cost of treatment.

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

2 Take the Photos

Have the six(6) required pre-operative photos taken of the area of the body you wish to improve. 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 body tilted back. Please view the examples below as reference.

In order for our doctors 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.

3 Submit the Forms, and Photos

Gather the following:

4 Hear Back From Us

After reviewing your information, Dr. Cochran will respond with a written report via email with his impressions and suggestions for a custom approach to achieve your goals, as well as provide you with an estimate of the cost of treatment.

Internet Consultation Form

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
By checking this box you agree to the Terms of Use listed here:
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. By checking this box 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 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.

This Internet Consultation is provided for general informational and educational purposes only. It is not intended to be all inclusive, diagnostic, or be interpreted as a form of medical advice. It does not and should never take the place of a formal in-person consultation with a physician. As such, it is not intended to be the provision of medical care, and it does not create a physician-patient relationship in accordance with Texas Medical Board Rules §174.8.

Schedule A Consultation
214.369.8123 Email Us