Houston Plastic Surgery

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Please fill out this form as completely as possible. Doing so will help Dr. Vitenas answer your questions more completely, and they will be answers based on your actual wants, needs and personal history. Your information is private and confidential. We hold your privacy in the highest regard, and suggest you read our Privacy Policy to learn more about why we need your information, and how we keep your personal information private.

This form, allows you to set up your initial consultation with Dr. Vitenas, or to ask the doctor for more detailed information about what cosmetic surgery can do for you.

I am making this request because:

I just started thinking about cosmetic surgery and welcome professional advice.

I am new to the area and need to find a cosmetic surgeon.

I am thinking about changing my doctor.

I have consulted other cosmetic surgeons and am looking for someone better.

What Cosmetic Procedures are you interested in?

Wrinkle Removal

BOTOX Cosmetic Injections

Fat Injections

Restylane

Skin Repair

Microdermabrasion

Chemical Peel / Phenol and Trichloroacetic Acid (TCA)

Laser Skin Resurfacing

Dermabrasion

Scar Repair / Scar Revision

Birthmark Removal

Mole Removal

Breast

Breast Enlargement / Augmentation Mammaplasty / Implants

Breast Lift / Mastopexy

Breast Implant Revision

Breast Reduction

Fat Removal

Liposuction, Lipoplasty, Lipectomy and Liposculpture employ various suction, tumescent, ultrasonic and ultrasound techniques to assist in removal of excess fat cells. My problem areas are:

Face --- Neck --- Arms --- Body

Back --- Abdomen --- Waist

Thighs --- Knees --- Ankles

Body

Body Contouring lifts, tightens and tucks sagging muscle and skin. My areas of interest are:

Tummy Tuck / Abdominoplasty

Arm Lift / Brachioplasty

Thigh Lift / Leg Lift

Body Lift / Bodylift / Circumferential Abdominoplasty

Neck Lift

Eyelids

Eyelid Surgery / Blepharoplasty

Face and Head

Face Lift / Facelift / Rhytidectomy

Nose Reshaping / Rhinoplasty

Forehead Lift / Brow Lift / Browlift / Endoscopic

Ear Surgery / Otoplasty

Lip Augmentation

Chin Augmentation / Implants / Genioplasty

Cheek Augmentation / Implants / Malarplasty

Male

Male Breast Reduction / Gynecomastia

Female

Labiaplasty / Vaginoplasty

How long have you been considering cosmetic surgery?

Less than 1 month.

1 to 6 months.

More than 6 months.

Have you consulted other doctors about cosmetic surgery?

No

Yes

Age:

Gender:

Female -- Male

Please list any existing medical conditions or allergies you have:

What is your expected budget:

Less than $1,000

$1,000 - $2,500

$2,500 - $5,000

$5,000 - $10,000

$10,000 - $20,000

$20,000 or More

How much do you know about the cosmetic procedures you are considering?

I just started my research.

I have been researching for at least one year.

I know someone who has had cosmetic surgery.

I am ready to meet with the doctor to learn more.

How soon are you considering having a cosmetic procedure?

Within 1 month.

Within 2 to 3 months.

Within 3 to 6 months.

After 6 months or more.

I have not decided to have a cosmetic procedure.

Height:

Weight (In Pounds):

Do you smoke?:

No --- Yes

What questions you want Dr. Vitenas to answer about cosmetic procedures?

YOUR CONTACT INFORMATION

Name:

I prefer to contacted by:

E-mail --- Phone -- No Preference

Email Address:

Telephone:

Area Code: Phone Number:

Best time to call is:

Submit Request:


Patient Forms

Patient Information Form
Patient Health Form
Notice of Privacy Practices
Acknowledgement Form
Self-Pay Policy


Paul Vitenas, Jr., M.D.

11914 Astoria Blvd., Suite 470
Houston, TX 77089
phone: 281-484-0088

Email Links:

Paul Vitenas, Jr., M.D.
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Jan Hughes
Director of Vitenas Skin Institute - Medical Aesthetician
Jan@DrVitenas.com

Jan, a Medical Aesthetician since 1993, is the director of Vitenas Skin Institute. She overseas and ensures that each patient receives the highest standards of care and professionalism each time they visit the office. With an uncommon level of warmth and personality she makes each of our patients feel as though they were visiting an old and dear friend with whom one can share their deepest feelings. Jan enjoys interacting with patients and takes great pride and satisfaction in witnessing the changes in our patients' lives as they fulfill their goals.


Anita Vennekotter, R.N.
Nurse Injector
Anita@DrVitenas.com

Anita specializes in aesthetic injectables including advanced techniques in Botox, Restylane, Radiesse, Juvederm, Cosmoplast, Captique, Sculptra, Sclerotherapy, Mesotherapy, and Lipodissolve. Anita's background includes extensive training and experience in these areas and has taught these techniques to other physicians and medical personnel in the United States and Canada. . She is a member of the Dermatology Nurses' Association and the Society of Plastic Surgical Skin Care Specialists, and has received certifications from the International Meso-Lipotherapy Society; as well as, certification in advanced Botox and filler techniques, including Sculptra, through various training programs. Anita prides herself in helping our patients' reach their aesthetic goals with a soft and natural look!


Jana Manzanales
Patient Care Coordinator
Jana@DrVitenas.com

Jana has 14 years of experience in the medical field, with the past 7 years of that experience in Plastic Surgery.  As your Patient Care Coordinator, she will walk you through every aspect of your cosmetic experience.  Jana will be by your side through your consultation, scheduling your surgery, pre operative education, and post operative care. With her extensive knowledge in the field of Plastic Surgery and her warm, compassionate personality, she develops a strong bond with each of our patients, helping to make their surgical experience special.  Her passion and sincere devotion to our patients separates her from all other patient care coordinators.


Ariane Keyworth
Front Office Coordinator
Ariane@DrVitenas.com

Ariane is responsible for the day to day functioning of the business aspect of the practice and acts as an assistant to Dr. Vitenas. With a degree in Healthcare Administration and soon to complete a Joint Masters Program in Business and Healthcare Administration she helps shape and implement our office policies and procedures.  Ariane's attention to detail and goal-oriented personality makes her an invaluable asset to our practice. 





Michelle Ware
Patient Coordinator
Michelle@DrVitenas.com

Michelle has a broad knowledge and experience of the Plastic Surgery field from the office administrative workings to the surgical procedures we perform. She is responsible for providing a personalized experience to our patients from their initial contact with our office through their surgical care. With her warm smile and pleasant personality, she bridges the front office with the clinical experience to ensure our patients receive true concierge service throughout their treatments.


Cosmetic Surgeon Houston Texas