Physician Photo Drop – Copy | Kawartha Plastic Surgery

Please upload your patient photos using this form

In addition to uploading patient photos please fax a referral form to the office and indicate photos have been sent

Patient Name*
First Last
Referring Physician*
First Last
Upload 1 or 2 Photos*
Drop files here or

Max. file size: 16 MB, Max. files: 2.
Accepted file types: jpg, jpeg, png, gif. Click submit once all images have finished uploading.
Please ensure a completed patient referral is also sent to our office by fax to accompany any uploaded photos. Referrals will only be processed once accompanying referral is received by fax.
Name
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Address

Suite 301 - 272 Charlotte Street, Peterborough, Ontario, Canada

Office Hours

The information contained on this website is intender for a Canadian audience noted. Information regarding cosmetic services is provided by the American Society of Plastic Surgeons as stock and accordingly prices are in American dollars. This website is designed to provide general information. Results from treatment and services are never guaranteed and may vary. Risk are inherent to any surgical or non surgical treatment and should be discussed in detail with your provider.

Non-Surgical Solutions

Surgical Solutions

Face

Body

Breast

Benign Lesions

Please upload your patient photos using this form

Address

Office Hours

Phone Number

Fax Number

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