Pre-Consultation Evaluation

Please do not complete this form unless you have been directed to by a practice staff member.

Thank you for choosing facial plastic surgery specialist Dr. Todd Hobgood for your upcoming consultation! With over 20 years of experience, Dr. Hobgood has earned a national reputation as one of the best facial plastic surgeons in Scottsdale and Phoenix, AZ. Due to his high demand, consultations are often scheduled months in advance. To ensure you have the most efficient and productive consultation experience, we ask that you start by completing a secure, encrypted, and HIPAA-compliant pre-consultation evaluation.

How does it work? First, you’ll upload photos of yourself and PDFs of relevant medical documents (we’ll show you how), and then you’ll fill out our online form to tell us more about your history. Once your form is submitted, Dr. Hobgood will personally review your case. Next, one of our expert patient care coordinators will call you to review your goals and history, provide cost estimates when possible, and potentially offer you an in-person (or virtual) consultation at your convenience.

Please note that there is no substitute for an in-person exam. Dr. Hobgood may revise his recommendations or even recommend against surgery after your consult if he feels this is best for you.

A note about candidacy: Dr. Hobgood and our team believe the best cosmetic outcomes are achieved when your health is optimized. For this reason, we have a strict limit for our surgical candidates of BMI 31. For more information and to calculate your own BMI, visit the CDC’s BMI calculator.

We look forward to helping you look and feel your best! If you have any questions, please contact us online or call (480) 418-6415.

Fields marked * are required.

Step 1:
Upload Your Photos

*Note: When shooting profile and three-quarter photos, it is extremely important that you rotate your torso and maintain alignment of the head and body rather than turning the neck to achieve the profile. Unfortunately, failure to do so will result in a delay in your care.

For all procedures, please upload the following 5 photos to help Dr. Hobgood effectively evaluate your concerns:

Drag and drop your own photo onto each photo below. Click or tap on a photo to browse images.

Drop photo here or
A front-facing photo
Front
Drop photo here or
Left profile photo
Left Profile
(please turn body as well,
to maintain alignment)
Drop photo here or
Right profile photo
Right Profile
(please turn body as well,
to maintain alignment)
Drop photo here or
left three quarter photo
3/4 Left
(please turn body as well,
to maintain alignment)
Drop photo here or
right three quarter photo
3/4 Right
(please turn body as well,
to maintain alignment)

For blepharoplasty (eyelid surgery), please upload these additional 3 photos:

Drop photo here or
A forward-facing close-up of the eyes
Closeup of Eyes
Drop photo here or
A close-up of the eyes closed
Closeup, Eyes Looking Up
Drop photo here or
A close-up of the eyes looking upward
Closeup, Eyes Closed

For rhinoplasty or revision rhinoplasty, please upload these additional 3 photos:

Drop photo here or
left smiling profile photo
Left Profile Smiling
(please turn body as well,
to maintain alignment)
Drop photo here or
right smiling profile photo
Right Profile Smiling
(please turn body as well,
to maintain alignment)
Drop photo here or
A front-facing photo taken from underneath (showing the nostrils)
Underneath View of Nostrils

Step 2:
Upload Your PDFs (optional)

Please upload PDFs of any relevant medical records, such as records of prior surgeries or injuries. (Limit of 4, up to 5MB each.)

Drop pdfs here or

Step 3:
Patient Information

Tell us a little more about you. As a reminder, all of your information will be encrypted and secure.

Marital Status*: Warning! You must select at least one option.
Race*: Warning! You must select at least one option.
Ok to leave a detailed message on voicemail?* Warning! You must select at least one option.
How did you hear about Hobgood Facial Plastic Surgery / theSkinSpa?* Warning! You must select at least one option.
Would you like to share your Protected Health Information with anyone?* Warning! You must select at least one option.

Protected Health Information

The following people may receive my PHI should they contact the office.

Person 1

Person 2

Person 3

With my signature below, I acknowledge and understand that the information provided will be kept in my confidential medical record and abided by until revoked by me in writing or in person. It is my responsibility to notify my healthcare provider should I change one or more of the telephone numbers or names listed above.

Procedures I Would Like To Discuss*

Warning! You must select at least one option.

Please note that Dr. Hobgood does not offer services related to sinus allergy, nasal fractures, trauma, scar revisions, or acne scarring. If you are interested in these services, feel free to reach out to our team for recommendations in our region.

Surgical Procedures

Nonsurgical Procedures

Current Skincare Regimen

Do you use any of the following?

Cosmetic History

Have you ever had or used any of the following?

Surgical History*

Warning! You must select at least one option.

Please list all other past (cosmetic and non-cosmetic) surgical procedures you have had, and include the approximate date of surgery. If none, check the “None” box below.

Medical History

Do you currently have or have a history of any of the following?

Eye History*

Warning! You must select at least one option.

Do you currently have or have a history of any of the following? If none check 'None'

Family History

Allergies

Medication History

Please list ALL Other Prescriptions and
Over-the-Counter Medications*:

Including all prescriptive, over-the-counter, hormone replacement, and supplement treatments you are currently receiving/using

Social History

Alcohol Use*: Warning! You must select at least one option.
Caffeine Use*: Warning! You must select at least one option.
Smoking/Tobacco/Vaping/Nicotine Gum or Patch Use*: Warning! You must select at least one option.
Type*:

Our Policies

Please take a moment to review our financial and cancellation policies.

Refund Policy

At Valley ENT, P.C., dba Hobgood Facial Plastic Surgery & the SkinSpa, we want you to be completely satisfied every time you shop with us. However, we know and understand there may be occasions where you want to return items ordered in error. That is why we offer a 14-day returns guarantee; so if for any reason you change your mind about your purchase, you can return it, unopened, in its original condition, within 14 days of the date you received it and receive a full refund of the product or goods purchased. Any damaged/defective items must be reported & returned within seven (7) days of your purchase to receive a full refund.

For questions, concerns, or to return a purchased product, please contact Susie directly at 480-214-9955 ext. 2854.

Financial Policy

All patients are responsible for payment at the time of service. Valley ENT, P.C., dba Hobgood Facial Plastic Surgery & the SkinSpa accepts the following forms of payment for services and products at our office:

  • Cash
  • Debit/Credit Cards (Visa / MasterCard / Discover / AMEX)
  • Cashier's Checks / Money Orders / Personal Checks (Please make all checks out to Valley ENT, not Dr. Hobgood — ALL returned checks will be assessed a $50 return-check fee. If a check is returned, personal checks will no longer be accepted.)
  • CareCredit (12-Month Plan with no interest, minimum of $200. If payment is not made in full at 12 months, all interest that was deferred will return with an interest rate of 29%. Or 24- or 36-Month Plan with a 14.9% interest rate starting immediately, $1,000 minimum.)

Cancellation / No-Show Policy

It is our policy to require 24 hours' notice of cancellation for a scheduled appointment. In the event you must cancel your appointment with less than a 24 hours' notice or do not call to cancel and miss your appointment, your deposited consultation fee will be forfeited.

Surgery Cancellation Policy

A scheduling deposit of 10% is required prior to any surgery. This deposit will be refunded if you cancel your surgery with at least six (6) weeks' notice.

  • Less than six (6) weeks' notice, we retain 10% of the total surgery fee.
  • Less than three (3) weeks' notice, we retain 25% of the total surgery fee.
  • Less than one (1) week's notice, we retain 50% of the total surgery fee.

By signing this form, you are agreeing to be contacted by email and telephone, and to our refund and cancellation policies.

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