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American Society of Plastic Surgeons
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Submit Your Story

The American Society of Plastic Surgeons wants to hear about your plastic surgery experience. Your story can help inform others considering plastic surgery. * indicates a required field.

First Name: *
Middle Initial:
Last Name:
Email: *
(Used for reference by ASPS only. This information will not be published.)
Occupation:
Age: *
Gender: *
Procedure: *

Your story:

Suggested topics:

  • How you found your surgeon
  • Reason for surgery
  • Overall experience
  • Recovery experience
  • Are you satisfied?
  • Breast augmentation stories: silicone or saline implants?
  • Other comments

*

Name of the plastic surgeon:
(Used for reference by ASPS only. This information will not be published.)
*

City and State of surgery:
(Used for reference by ASPS only. This information will not be published.)
*

Terms of Agreement:
I authorize the American Society of Plastic Surgeons (ASPS) to post my story on the ASPS Web Site. I understand that ASPS will edit my story for grammar and will remove the name of my physician according to ASPS policy. I understand that the story I submit shall become the property of ASPS for the purpose of informing the general public about plastic surgery procedure and methods. I acknowledge that I will not receive compensation for submitting my story.

Neither I, nor any member of my family, will be identified by full name. Publication of my story is up to the sole discretion of ASPS.

I certify that I have read the above Authorization and Release and full understand its terms.

*