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Naficy Plastic Surgery & Rejuvenation Center

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"Patients' Choice Award" by Vitals.com

Dr. Sam Naficy has been awarded the "Patients' Choice Award" by Vitals.com - a website dedicated to rating the quality of physicians across the country. Out of 720,000 physicians, only 5% received this honor.


Schedule a Dermatology Consultation

You may use this form to request a dermatology consultation and/or treatment. After receiving your contact information, desired days or dates, and desired time frames, we shall contact you to notify you of available dates and times for your consultation visit.

First Name:
Last Name:
Address:
City:
State:
Zip:
Email:
Day time phone:
Evening phone:

How do you wish to be contacted:

 Email      Phone      Either

Type of Appointment:
Dermatology Consultation
Dermatology Consultation and same day treatment
Cosmetic Consultation: Non-surgical
Cosmetic Consultation: Surgical

Date and Time of Appointment:

First Preference:
Date: Time:

Second Preference:
Date: Time:

Third Preference:
Date: Time:

Type of dermatology service(s) you are considering:
(check all that apply)

Medical Dermatology Cosmetic Dermatology
Acne treatment Botox & Dysport
Acne scar improvement Restylane
Skin cancer screening Radiesse
Skin cancer treatment Fotofacial
Mohs surgery Intensive fotofacial
Skin growths Skin tightening
Age spots Thermage
Mole check Laser vein removal
Surgical mole removal Sclerotherapy
Laser mole removal Laser resurfacing
Cysts Fractional laser (Frax/Fx)
Lipomas Laser hair removal
Rosacea Fat injection
Large pores Scar revision
Pigmentation problems Microdermabrasion
Melasma Retinoic & Glycolic peel

Additional comments:

Optionally include photos to help with discussion:
Photo 1:
Photo 2:
Photo 3:
Photo 4:

    



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Naficy Plastic Surgery & Rejuvenation Center     1110 112th Ave NE Suite 150 Bellevue, WA 98004     (425) 450-0880