Virtual Consultation Manhattan, NY

To help our patients, we are now offering virtual consultations with Dr. Diktaban. Please fill out the form below to start a virtual appointment. First, we will collect your information and before and after images to make sure you are a candidate, then we will reach out to set up a personalized one-on-one video consultation with Dr. Diktaban. Certain procedures like rhinoplasty are limited because he cannot examine the inside of the nose which plays an important role in breathing and the direction of the external appearance. However, the external appearance of the nose is definitely viewable on video and serves as a good starting point in your consultation journey.

Contents

Virtual Consultation Form

First Name*
Last Name*
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Name
First Last
Email*
Phone*
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City*
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State*
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Zip Code*
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Country*
Date of Birth*
Month
Day
Year
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Height*
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Unit (IN/CM)*
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Weight*
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Unit (LBS/KG)*
Do you smoke?*
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Do you drink alcohol?*
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Do you have children?*
Procedure of Interest*
Preferred Video Option for Virtual Consult*
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Previous Surgeries*
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Current Medications*
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Herbal Supplements or Vitamins*
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Known Drug Allergies*
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Any Medical Conditions*
Patient Photos

Take at least 1 photo of each area and attach the photos below.
- Only take selfies for face procedures
- Have someone else take the photo or use a mirror for breast or body procedures
- For face procedures, only include a picture of your face
- For body or breast procedures, you do not need to include your face
Front
Drop files here or

Max. file size: 1,000 MB.
Angle Views
Drop files here or

Max. file size: 1,000 MB.
Side Views
Drop files here or

Max. file size: 1,000 MB.
Form terms*
Communications through our website or via email are not encrypted and are not necessarily secure. Use of the internet or email to communicate with Dr. Diktaban is for your convenience only, and by using them, you assume the risk of unauthorized use. By checking this box you hereby agree to hold Dr. Theodore Diktaban, its doctors, affiliates and vendors, harmless from any hacking or any other unauthorized use of your personal information by outside parties.
- I Agree
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Desired Surgery Date*
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Email
This field is for validation purposes and should be left unchanged.

Virtual Consultation

Virtual Consultation Form

Patient Photos

Theodore Diktaban, MD, FACS
Double Board-Certified Plastic Surgeon

Location

Office Hours

Virtual Consultation in Manhattan, New York City, NY

Virtual Consultation

Virtual Consultation Form

Patient Photos

Theodore Diktaban, MD, FACSDouble Board-Certified Plastic Surgeon

Office Hours

Theodore Diktaban, MD, FACS
Double Board-Certified Plastic Surgeon