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Am I a candidate for a facelift?Facelift Survey

Begin Your Journey

Step 1 of 2

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Take this quick survey to find out if you are a Facelift Candidate!
I am*
I have been seriously thinking about a facelift for*
The part that bothers me MOST about my face is:*
(select all that apply)
- Neck
- Jowls
- Marionette Lines (lines from corners of mouth to chin)
- Wrinkles on skin
- Overall Sagging
- Volume Loss
- Other
Other*
Rate how satisfied you are when you look in the mirror today:*
(1 = not satisfied, 10 = very satisfied)
- 1
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- 10
My biggest concerns when considering a facelift is:*
(select all that apply)
- Pain
- Cost
- Downtime
- Nervous about the outcome
- Infection
- Going under anesthesia
- Other
Other*
My reason for considering a facelift now is:*
- I have a special occasion I want to be ready for!
- I am sick and tired of looking in the mirror
- I want to look younger and/or refreshed
- I want to feel better about myself and the way I look
- Other
Other*
I would describe myself as a happy person*
(1 = not happy, 10 = very happy)
- 1
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- 10
The time I am seriously considering this is:*
- Within 6 months
- 6 months to a year
- I am just looking for information

You're almost done!

Fill out the fields below and we'll send you the results of your survey along with other helpful information regarding facelifts.
First Name*
Last Name*
Email*
Phone*
Current Location (City, State)*
How did you hear about us?*
Terms Agreement*
I accept the Terms of Use & agree to receive monthly specials, newsletters, etc.*
Facelift Book
I would like a copy of Dr. Williams facelift book.

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Latham, Albany, NY

1072 Troy-Schenectady Rd
Latham , NY 12110
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110 E 60th St #908, New York, NY 10022
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St. Thomas Virgin, US Virgin Islands

Palm Plaza 260-260A Estate Chocolate Hole, Suite 1D
St John, VI 00802
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Saratoga Springs

60 Railroad Place, Suite 102
Saratoga Springs, NY 12866
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