1. What is your current age? 2. What is your height and weight? 3. Do you have sagging of the breast? 4. Have you undergone previous breast surgery? 5. Do you regularly take any prescription medications? 6. Do you currently or have you in the past used any hormones including anabolic steroids? 7. Do you smoke tobacco or use nicotine products? 8. Are you in good overall general medical health? 8. Which image most closely resembles your current appearance?
10. Please provide us with your contact information: --