Contact Us

If you are considering cosmetic surgery or our other services and would like more information or our office to contact you, please fill out the inquiry form below. Dr. Yarinsky will personally answer you by e-mail. If you wish to speak by phone with our nursing staff, office manager, patient coordinators, skin care specialist, Endermologie/Lipomassage technician, sclerotherapy nurse, laser hair removal technician or need help with financing your procedure, call toll free 1-888-884-4448 or 518-290-1919 weekdays between 8am and 4pm (Fridays till 3pm). We are looking forward to hearing from you!

INQUIRY FORM:

Please tell us about yourself.

1. First Name(required)
2. Last Name(required)
3. Street Address(required)
4. Apartment/Suite
5. City(required)
6. State(required)
7. Phone Number(required)
8. Email Address(valid email required)
9. Age(required)
10. Gender(required)
11. Height
12. Weight
13. Do you smoke?
14. Yes No
15. What type of cosmetic surgery are you interested in?(required)
16. Have you consulted other plastic surgeons about your desired procedure?
17. Yes No
18. Have you had previous cosmetic surgery?
19. Yes No
20. Please list any existing medical conditions or allergies you may have(required)
21. Would you like to make an appointment?
22. Yes No
23. What time frame are you looking at? Choose One... I need immediate surgery I would like to schedule for within 6 months I would like to schedule for within a year I am just generally interested
24. Contact me by:
25. Email Mail Phone
26. Questions/Comments
27. 

 

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