Directory Surgeon Complaint / Feedback Form

If you had a negative experience with a surgeon listed on the NPOAS Directory, please fill out the form below. The Flat Friendly Surgeons Directory directly empowers women going flat to advocate for and protect their choice, and your feedback is critical to ensuring the integrity of this important tool. Thank you!

Surgeon Complaint / Feedback Form

Did you have a negative experience with a surgeon listed on the Flat Friendly Surgeons Directory? Please let us know. We welcome your feedback, and we review listings according to our listing review policy published at NotPuttingonaShirt.org/Policies.

Your Name(Required)

First Last

Your Email(Required)

Surgeon's Name

First Last

Please select which of the following statements is true for your situation.(Required)

I had surgery with the surgeon in question.

I consulted with the surgeon in question, but did not have surgery with them.

What type of surgery did you have with this surgeon?

Initial mastectomy or mastectomies

Revision

Explant of implants or expanders

Other (please explain below)

Please explain what type of surgery you had with this surgeon ("other").

In what year did you have your surgery with this surgeon?

In what year did you consult with this surgeon?

Please tell us about your experience with this surgeon.(Required)

Upload Closure Photo

Drop files here or

Max. file size: 2 GB, Max. files: 4.

Please upload a >6wk post operative photo of your surgical closure for confidential use in our committee review process. We may not be able to make a final determination without a photo.

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Surgeon Complaint / Feedback Form

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