Patient Forms
ONLINE FORMS (RECOMMENDED)
Patient Registration Form: For new patients
Telehealth Consent: For Established patients requesting virtual consults or follow ups via phone, Facetime, or Zoom
Covid-19 Screening: To be completed by all patients on the day they arrive at our office before every appointment
Photo/Document Request Form: Send us your photos or documents securely and encrypted
Surgery Booking Form – Credit Card Payment
Authorization for Release of Medical Records
HIPAA Unencrypted Email and Text Message Consent
Surgical Consents:
Surgical Consents General (no implants)
General Surgical Consents with Breast Implants
Breast Augmentation Silicone Implants Informed Consent ASPS
Breast Augmentation Saline Implants Informed Consent ASPS
Breast Surgery Pre and Post Operative Instructions
Mastopexy Informed Consent ASPS
Breast Reduction Informed Consent ASPS
Facelift Informed Consent ASPS
Liposuction Informed Consent ASPS
Liposuction Pre and Post op Instructions
Facelift pre and post op instructions, timeline, with lipo
Upper Lid Blepharoplasty Informed Consent ASPS and Home Care
Lower Lid Blepharoplasty Informed Consent and Home
Upper and Lower Blepharoplasty Informed Consent ASPS and Home Care
Abdominoplasty Informed Consent and Home Care
Browlift Informed Consent ASPS
DOWNLOADABLE FORMS
Directions to Office
Medicare Forms (Insurance)
Patient Registration
Pre-Operative Paperwork:
Drugs to avoid prior to surgery
Miscellaneous Operative Consent
Armlift Consent
Belt Lipectomy Consent
Blepharoplasty
Breast Evaluation Form
Breast Augmentation
Breast Reduction Medicare Criteria
Browlift
Dermabrasion
Facelift Consent
Mastopexy Consent
Rhinoplasty Consent
Thigh Lift Consent
Information on Nonopioid Alternatives for the Treatment of Pain:
This pamphlet provides information about nonopioid alternative treatments to manage pain.
Resources
Allergan
American Society of Plastic Surgeons
Beauty for Life
Bioform Medical
Bonita Community Health Center
BOTOX® Cosmetic
Cape Coral Hospital
CareCredit
Dysport™
Gulf Coast Hospital
HealthPark Medical Center
Juvéderm®
LaRoche Posay
Latisse®
Lee Memorial Hospital
Mayo Clinic
Mentor Corporation
Perlane®
Radiesse®
Restylane®
Online Plastic Surgery Resource
Skin Ceuticals®
