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Virtual Consultation

Start Your Virtual Consultation Today

We’re excited to help you explore your aesthetic goals. To get started, please fill out the form below and upload your photos. Your information will remain private and is transmitted securely in compliance with HIPAA and California privacy laws.

Step 1: Tell Us About Yourself

Health declaration

Please fill out the following form.

Date of birth
Month
Day
Year

To ensure an accurate virtual consultation, please upload high-quality photos taken in good lighting. Ideally, submit:

Accepted Formats: JPG, PNG, PDF | Max File Size: 10MB per image

Secure Upload: Files are encrypted during transfer and stored securely.

I agree not to submit any urgent medical concerns or emergencies via this form.

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

I understand that this form is for informational purposes only and does not constitute a medical diagnosis or the establishment of a physician-patient relationship. Any treatment recommendations are preliminary and must be confirmed in person during a full clinical evaluation.


I acknowledge that my photos and information will be used by Dr. Farzaneh and Truecare Cosmetic Surgery & Med Spa solely for the purposes of this virtual consultation.


I confirm that I am over the age of 18 and reside in California (or am physically present in California during submission).


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