Body contouring surgery questionnaire - Gorin Plastic Surgery ... 2026

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Click ‘Get Form’ to open the Body contouring surgery questionnaire in our editor.
Begin by entering your name and the date at the top of the form. This personal information is essential for your consultation.
Fill in your height and weight, as well as your maximum weight during pregnancy. This data helps assess your suitability for surgery.
Indicate the number of pregnancies and children you have, along with any future pregnancies planned. Also, specify if you are currently pregnant.
Provide details regarding any personal or family history of blood clots or pulmonary embolism, and confirm if you participate in a regular exercise program.
Answer questions about any special diets you've followed in the past year and when you are considering having surgery.
For breast surgery candidates, indicate previous mammograms and provide relevant details about breast health history.
Finally, circle the areas of your body that you wish to discuss today and add any notes for Dr. Gorin in the designated sections.

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