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  • BREAST AUGMENTATION, LIFT OR REDUCTION

  • For patient to complete

    Thinking of your breasts in the past week, please tick the circle that indicates how satisfied or dissatisfied have you been with:

  • very dissatisfied somewhat satisfied very satisfied
  • very dissatisfied somewhat satisfied very satisfied
  • very dissatisfied somewhat satisfied very satisfied
  • very dissatisfied somewhat satisfied very satisfied

  • Thank You!

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