Patient Forms - Reconstructive Services

Effective April 9, 2014, Northland Plastic Surgery is implementing a new registration process called Phreesia. This new registration process will allow reconstructive and cosmetic patients to fill out their information on a tablet in our office. Please arrive 20 minutes in advance of your appointment to register. 

Below you will find several forms we will need for registration. Please take a few minutes to print them out and complete them. 

To view the following "Download/Print" forms, please download the latest free version of Adobe Reader. get adobe reader

Welcome Form: Download/Print

HIPAA Notice: Download/Print

Patient Notices and Authorizations: Download/Print

Permissions to Discuss Health: Download/Print

Map: Download/Print

Payment for services and products will be collected at the time of the appointment. Also for your convenience we accept Visa, MasterCard, and Discover. See our payment options for more information.

  •  Reconstructive4
  • Mixed4
  • Mixed8
  • surgeon
  •  surgeon
  •  breast implant
  •  Skin5
  • Cosmetic5
  • Cosmetic6
  • Cosmetic7
  • SkinCare6
  • Mixed8
  • Reconstructive5
  • "I can move better than before. My legs have more flexibility and it is easier to walk. These procedures have been very effective - they have made me happier and my scars look better than ever." ~ Ashley
  • "My experiences at Northland Plastic Surgery have been very positive. They have gone above and beyond to make sure I always received the necessary treatments." ~ Candy
  • "The surgery effectively removed the folds of my eyelids which had impaired my vision. Northland Plastic Surgery is an immaculate facility with efficient and friendly staff. I will recommend NPS to others." ~ Richard