For your convenience, we have provided downloadable copies of the New Patient Forms at the links below. Simply print and complete the top five (5) forms, and bring them with you to your visit.

Non-Medicare Patient Forms

1. New Patient Registration
2. Financial Policy and Agreement
3. Medical History Form
4. Authorization for Release of Information
5. HIPAA Acknowledgement of NPP
6. HIPAA Notice of Privacy Policies (Patient Copy)
7. Consent for Treatment of Minors

Medical Records Release Forms

Authorization to Release Medical Records
Authorization to Obtain Medical Records

Cosmetic Consult

Cosmetic Patient Consultation Form
SculpSure® Consultation Form
Sculpsure Clinical Treatment Consultation Form
Photo Release Form