Virtual Consultation Registration

  • Home
  • Virtual Consultation Registration

Register for a virtual consultation with Dr. Richard Parfitt and take the first step toward your facial rejuvenation goals from the comfort of your home. Parfitt Facial Cosmetic Surgery Center proudly offers secure online consultations for patients in Madison, Appleton, and throughout Wisconsin. Connect directly with Dr. Parfitt to discuss your facial plastic surgery or non-surgical treatment options.

MIDDLETON: (608) 831-3991
APPLETON: (920) 730-1309

To schedule a virtual consultation please complete this request. If we haven’t already booked the appointment we will reach out to you soon. If you have additional questions please contact our Surgical Coordinator at angela@facialplastics.com or (608) 831-4551

After you hit SUBMIT you will see a confirmation note below. If you have uploaded photos this may take a few minutes. Make sure each individual image is less than 256MB or they will not be received.

Patient Consultation Registration Form

MM slash DD slash YYYY
Birth Date(Required)
Address(Required)
How can we use your phone number?
If you would like to book a Skype consultation please list your Skype account name so that Dr. Parfitt can contact you.
If you would like to book a FaceTime appointment with Dr. Parfitt please list the number he should use to call you.
If you would like to video chat with something other than Skype or FaceTime please list the details here.
Does your job require strenuous activity or protective gear over your face?
How did you hear about us?
Referral Source. Please be specific. If more than one, please list which was most influential. Please list the first and last name of any person or professional who referred you. We have a great referral reward system!

Please list all allergies along with your reaction. If you do not have any allergies please type "None"
Please list all medications your take including supplements. If you do not take any medications or supplements type "None".
Please describe any chronic health concerns or skin conditions.
Have you had any prior facial surgery?
Drop files here or
Max. file size: 256 MB, Max. files: 6.
    HOW TO TAKE PHOTOS: – Another individual should take these photos of you – The photographer should be AT LEAST 6 feet away and ZOOM In from that distance so that the head fills the frame.  – Stand in front of a blank wall or background – Photos should be full-face headshots (from top of head to collar) from the front and also the side – Do not smile in photos – Make sure photos are clear and not blurry or distorted -You may need to reduce the size of the image to successfully upload. If you are unable to upload photos to this form please email them to angela@facialplastics.com
    This field is for validation purposes and should be left unchanged.

    Our Locations in Wisconsin!

    Office Hours
    Monday: 9.00am - 6.00pm
    Tuesday - Thursday: 8.30am - 5.00pm
    Friday: 9.00am - 1.00pm
    x

    If you’re a current patient with an urgent concern following your procedure, please follow the post-operative contact instructions provided to you by our office. For all other inquiries, contact us using the information below.

    Contact Us!

    Opening Hours: Mon -Sat: 7.00am – 19.00pm

    Opening Hours: Mon -Sat: 7.00am – 19.00pm