Online Consultation Form

Penile Girth Enhancement
Consultation Form

Please follow the form below in order to send us your medical information.

Personal Information

Please measure your penis and fill in the following section:


Full Erection

Shape of your penis during full erection:

Size of your glans during full erection:



Please check if you have received any other surgical procedures or treatments for penile enhancement:

Previous Genitalia Treatments:

Pre existing genitalia conditions. (please check all that apply):

If you perform home penile enhancement procedures or treatments, please mark:

Interests (mark all that apply):

Interests (mark all that apply):


Please complete the form to the best of your knowledge. All information is kept in strictest confidence and your pictures may be used only upon written permission. This information is handled in absolute discretion and confidentiality. Although we are not a US based company, we follow the strictest rules of non disclosure established by the US Health Insurance Portability and Accountability Act (HIPAA). Our confidenciality policies are governed by the Mexican Law in accordance with the articles 8, 15, 16 and 17 of the Federal Law for Personal Data Protection in Possession of Individuals.

Contact Info

Blvd. Agua Caliente 4558, Suites 1106-1108
Col. Aviacion, Tijuana, BC (Mexico) 22420

US – +1 (619) 308-7268
MX – +52 (664) 687-4848