PATIENT FORMS:

For your convenience, the following Patient Forms are available for downloading and printing:

  • New Patient Forms - Skin Care Center Services
    (when you are going to be seeing our Skin Care Specialist for the first time - or if it has been longer than three years since you saw her last).
  • New Patient Forms - Cosmetic Services
    (when you are going to be seeing one of our plastic surgeons for the first time - or if it has been longer than three years since you last saw one of them - to discuss a cosmetic procedure that is not paid for by insurance companies- breast augmentation, tummy tuck, etc.).
  • New Patient Forms – Reconstructive (medically necessary services)
    (when you are going to be seeing one of our plastic surgeons for the first time - or if it has been longer than three years since you last saw one of them - to discuss a procedure that will be billed to your insurance company (breast reduction, breast reconstruction, lesion removal, hand surgery, etc.).

You may submit your patient information in any of the following ways:

  1. Download and print the forms. Complete them and bring them with you on the day of your appointment.
  2. Arrive 15 minutes in advance of your appointment to fill out these forms at our office.
  3. Request that the forms to be mailed to you (while on the phone with us scheduling your appointment). Complete them and bring them with you on the day of your appointment

AUTHORIZATION FOR RELEASE OF CONFIDENTAL MEDICAL INFORMATION
(If you need a copy of your medical records from us, please print out and mail in this form.)

Call us with your requests and any additional questions at (218) 724-7363 or (800) 964-6891