"By signing the above, I am stating that I am board-certified in plastic surgery by the American Board of Plastic Surgeons or the Royal College of Physicians and Surgeons of Canada, that my medical license in the state where I am practicing is current and has not been revoked (nor has it been revoked in any other state), and that I am not currently being investigated or disciplined, or being considered for discipline, by the Board of Medical Examiners of any state or country, nor has any Medical Board or comparable supervisory board deemed it necessary to bring disciplinary action against me in the past.

I further state that I will honestly answer any questons my patients ask me regarding malpractice settlements or judgments in the past or present. I also promise to inform, immediately, the webmaster of www.BoardCertifiedPlasticSurgeon.com if the status of any of the above specifications have changed at any time during my listing period.