Submit to Gallery

Contribute to the AFC Gallery!

This database serves several critical functions in improving the standard of patient care in this setting. It facilitates clear communication between patient and provider & helps to set expectations; it allows patients facing surgery to visualize what they might look like should they choose the AFC option; and it provides critical data for future AFC research and training.

Download the sample patient photo release form:  (PDF)   (Word)

Please provide as much information as possible, and contact us if you have any questions about this project.

"*" indicates required fields

About the Provider

Provider Name*
Email*

About the Patient

Accepted file types: jpg, jpeg, png, gif, Max. file size: 2 GB.
Accepted file types: jpg, jpeg, png, gif, Max. file size: 2 GB.
(Optional) In many cases, a hybrid surgical approach may be necessary to individualize and optimize the outcome. Please use this space to describe your surgical approach.
Incision Pattern