You need to email Dr. Miro and ask. He is in the US a lot for various medical conferences and to visit his daughter. So he is all over the place. Commonly in Maryland and Florida, but others have seen him in San Francisco. I saw him in Oklahoma City. Basically he tells you when he'll be in the US and where, and you figure out if you can see him there or not, or wait until he's in a different city.
I was not pumping when I had my consult; I started pumping afterwards.
He does not like to do surgery if you are not of a certain size (sorry, I don't know what that is). Your junk needs to be a certain size so that when he releases it, you have an actual small dick and not a nub. He wants you to be happy. If he doesn't think you are large enough, he likely will tell you to pump and then reconsult. He basically looked at my junk and said if I pumped regularly I'd be ready in 6 months, and I was. He's less about collecting your money and more about giving you the best result he can with your anatomy so you're happy.
Jay