Comprehensive Brazilian Butt Lift BBL Questionnaire

This questionnaire will help us give you as much detailed information about your body type as possible.

Name (required)


Date: (required)


Phone Number: (required)


Your Email (required)


Current Weight (required)


Current Height (required)


Are you pregnant? (required)
YesNo


Are you currently breastfeeding, or have you breastfed in the past six months?
YesNo


Are you a smoker?
YesNo


Has your weight fluctuated more than 20 pounds in the past six months?
YesNo


If you answered the above question "Yes":

How long ago?

By how much weight?


Will you be able to maintain your current weight for the next six months? It’s imperative that you don’t lose weight during this time period
YesNo


Have you had liposuction done in your intended area before?
YesNo


Would you be satisfied with 50-75% fat removal from the intended area?
YesNo


Have you researched other butt augmentation options?
YesNo


Does your family support this decision?
YesNo


If no, may we ask why?


What are your expectations of the procedure?


Which body shape do you most identify with?
Pear-shaped: I have a small bust, narrow shoulders, with wider hips, thighs, and butt.Athletic-shaped: I don’t have a defined waistline. I’m straight up and down.Apple-shaped: I have ample bust, a rounded stomach, and slimmer hips.Hourglass-shaped: I have ample bust, curvy hips, and a defined slimmer waist.Slender-shaped: I am very slim with very little curves.Inverted-triangle-shaped: My shoulders are broader than my hips.



or

Enter your weight

Enter your height

Calculate BMI

Care Plastic Surgery 7:16 pm