Center for Cosmetic and Laser Surgery
630-851-3223
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Center for Cosmetic and Laser Surgery
630-851-3223
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Face
Face Lift
Eyelid / Eyebrow Lift Surgery
Nose Surgery
Neck Lift
Chin & Cheek Implants
Otoplasty
Rhinoplasty Naperville
Laser Skin Resurfacing
Botox & Fillers
HydraFacial Treatment
ThermiAesthetics
Kybella™
Halo Skin Rejuvenation / Resurfacing
Volumizing Dermal Fillers
Fat Transfer
Lip Enhancement
Breast
Breast Augmentation
Candidates
Procedure Performed
Post Procedure
Silicone Vs. Saline Breast Implants
Breast Lift
Breast Reduction
Mommy Makeover
Male Breast Reduction
Body
Liposuction
Tummy Tuck
Coolsculpting
Hyperhidrosis
Body Contouring
Men’s Room
Pectoral Implants for Men
Med Spa
Non-Surgical Treatments
Skin Care Products
Gift Cards
Infinity Medical Spa
Treatment Options
Treatments perfect for 20+
Treatments perfect for 30+
Treatments perfect for 40+
Treatments perfect for 50+
Treatments perfect for 60+
Treatments perfect for Men
About Us
Mission Statement
Bryan W. Rubach, M.D.
Joseph A. Franco, M.D.
Jill Jensen, R.N.
Medical Aesthetician
Cosmetic Surgery FAQ
Testimonials
Patient Care Coordinator
Patient Information
Patient Medical Form
Finance
Media
Videos
Why Cosmetic Surgery?
Before & After Photos
Facial Plastic Surgery
Breast
Body
Blog
Contact
Events
Offer
Home
Face
Face Lift
Eyelid / Eyebrow Lift Surgery
Nose Surgery
Neck Lift
Chin & Cheek Implants
Otoplasty
Rhinoplasty Naperville
Laser Skin Resurfacing
Botox & Fillers
HydraFacial Treatment
ThermiAesthetics
Kybella™
Halo Skin Rejuvenation / Resurfacing
Volumizing Dermal Fillers
Fat Transfer
Lip Enhancement
Breast
Breast Augmentation
Candidates
Procedure Performed
Post Procedure
Silicone Vs. Saline Breast Implants
Breast Lift
Breast Reduction
Mommy Makeover
Male Breast Reduction
Body
Liposuction
Tummy Tuck
Coolsculpting
Hyperhidrosis
Body Contouring
Men’s Room
Pectoral Implants for Men
Med Spa
Non-Surgical Treatments
Skin Care Products
Gift Cards
Infinity Medical Spa
Treatment Options
Treatments perfect for 20+
Treatments perfect for 30+
Treatments perfect for 40+
Treatments perfect for 50+
Treatments perfect for 60+
Treatments perfect for Men
About Us
Mission Statement
Bryan W. Rubach, M.D.
Joseph A. Franco, M.D.
Jill Jensen, R.N.
Medical Aesthetician
Cosmetic Surgery FAQ
Testimonials
Patient Care Coordinator
Patient Information
Patient Medical Form
Finance
Media
Videos
Why Cosmetic Surgery?
Before & After Photos
Facial Plastic Surgery
Breast
Body
Blog
Contact
Events
Offer
Patient Medical Form
Patient’s Name
First Name
Last Name
Age
Email
Medical History
Hypertension
Yes
No
Diabetes
Yes
No
Heart Disease
Yes
No
Skin Cancer
Yes
No
Hypertrophic Scarring (Keloid)
Yes
No
Aspirin/Fish Oil Use
Yes
No
Tobacco Use
Yes
No
Accutane Treatment
Yes
No
Previous Aesthetic Surgery
Yes
No
Please list all medications you are currently taking (perscription, over the counter, or naturopathic):
Please list any know allergies to medications:
Please list all past surgeries:
Please indicate the services that you are interested in. Use the space provided to specify a particular area of concern:
Botox, XEOMIN Injections (Used to treat frown lines & crow’s feet)
Juvederm/Radiesse/Sculptra Injections – indicate area
Laser Resurfacing/Skin Rejuvenation
Face/Neck/Brow Lift
Eyelid Surgery
Nasal Refinement/Nose Surgery
Ultherapy
CoolSculpting
Liposuction – Please indicate area(s)
Breast Augmentation/Breast Lift
Tummy Tuck
Other – please specify
Request a Consultation
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Face Lift
Eye Lift / Brow Lift
Nose Surgery
Neck Lift
Chin & Cheek Implants
Otoplasty
Laser Skin Resurfacing
Botox & Fillers
ThermiAesthetics
Breast Augmentation
Breast Lift
Breast Reduction
Mommy Makeover
Male Breast Reduction
Liposuction
Tummy Tuck
Coolsculpting
Hyperhidrosis
Men’s Room
Non-Surgical Treatment
Mission Statement
Bryan W. Rubach, M.D.
Joseph A. Franco, M.D.
Jill Jensen, R.N.
Medical Aesthetician
Cosmetic Surgery FAQ
Testimonials
Patient Care Coordinator
Patient Information
Patient Medical Form
Finance
Media
Videos
Why Cosmetic Surgery?
Center For Cosmetic and Laser Surgery
in Naperville & Chicago, IL
1331 W 75th St. #306
Naperville, IL 60540
(630) 851-3223
info@cclscosmetic.com
request aN Appointment
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