Consultation Request

Flaum Eye Institute / Center for Facial Aesthetics / Consultation Request

You can use this form to request a pre-operative consultation with physicians at the Flaum Eye Aesthetics Center only. Please be aware that elective aesthetic procedures are not covered by traditional insurance. There is a $100 consultation fee due at your initial visit. This fee can be applied to the cost of any elective aesthetic fee performed by Dr. Gonzalez.

Request A Non-Urgent Appointment

For questions about your appointment, please contact us at (585) 275-7080. Use this form to request a non-urgent appointment only. All requests will be processed within 24 hours during regular business hours, Monday - Friday, 8:00 am-4:30 pm.

Name First Name:

Last Name:

Address Street:

City:

State:

Zip Code:

Contact Information Home Phone:

( ) -

Work Phone:

( ) -

Email Address:

Contact me between 8:00 a.m. and 4:30 p.m. via:

Home PhoneWork PhoneEmail

I am primarily interested in:

Botox & FillersLaser Skin ResurfacingSurgical Rejuvenation

Scheduling Preferences

Please indicate your first choice for day and time.

Day of week:

Time of day:

Please indicate your second choice for day and time.

Day of week:

Time of day:

Additional Information Promo Code:

How did you hear about Flaum Eye Institute?:

Our Privacy Policy

�鶹��Ƶ

Consultation Request

Request A Non-Urgent Appointment