Virtual Consultation

iStock_79867679_MEDIUM

At Aesthetic Surgery Center Antwerp, we frequently treat patients from out of town. For your convenience, we have created the form below which allows you to submit information about your surgical goals and photographs of yourself for Dr. Van Look to review. If you have questions about arranging a GoToMeeting virtual consultation with Dr. Van Look, or if you would like more information before submitting the virtual consultation form, please call our office at 32 (0)3 / 237 35 72.

For best photo evaluation results, use a solid background and send both a front and side view of each area to be evaluated.

Virtual Consultation Form

Form for virtual consultation page.
  • Drop files here or
    Accepted file types: jpg, gif, png, pdf.