Patient Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Contact Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Contact Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Procedures of Interest {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
How did you hear about us? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Photo Upload
- Stand in a well lit room
- Take 3 photos in different views
- Use a background, like a wall or a door
- Position yourself 3-4 feet away from the camera.
- Try to center the area of interest in the middle of the photo.
- Follow the sample images as a visual aid.

Rhinoplasty Only
{ binding firstError.message }
Image Upload: Front View {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Image Upload: Side View 1 {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Image Upload: Other Side View {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Image Upload: Rhinoplasty Only {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }