Virtual Consultation

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Virtual Consultation

We’re so glad you’ve considered doing a virtual consultation with Dr. Jason Cooper.

Once you submit this form, we will be in contact with you asap to confirm we received your request and to gather any additional information we might need before setting up your consultation.

We look forward to hearing how we can help you and be a part of your journey!

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HIPAA ACKNOWLEDGEMENT

Please be aware that this is a secure email network under HIPAA guidelines. Do not submit any personal or private information unless you are authorized and have voluntarily consented to do so. We are not liable for any HIPAA violations. Understand that if you email us, you are agreeing to the use of this secure method and understand that all replies will be sent by standard (unsecured) email, which you are hereby authorizing. By checking this box you hereby agree to hold Jason Cooper MD Plastic Surgery & Medspa, including its doctors and affiliates, harmless from any hacking or any other unauthorized use of your personal information by outside parties.

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By checking this box, I acknowledge my understanding of the HIPAA Policy and agree with its contents. *

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Virtual Consultation

Virtual Consultation

HIPAA ACKNOWLEDGEMENT

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