Patient Forms Templates
Please Print, Fill up and sign the forms attached below before receiving any treatment for any Neurotoxins treatments such as Botox, Xeomin or Dysport. (This will save you time) if you do not do so, then it will be filled in the medical office. You can call us for any question /concern
Please note that Botox, Xeomin and Dysport are medical procedures performed by trained medical professional ( Medical Doctors (MD) and Nurse Practitioners (NP) ) and requires proper documentation of the patient Medical History, signed Patient Consent Form, as well as signed Post-Treatment Written Instructions. Before receiving any of these treatments by our medical professionals the patient must provide valid (non-expired) US ID (Identification) ( State Driver License, Passport Card or any other Government-authorized form). All forms must be completely filled and signed by the patient before receiving care.
You can :
1. Print the (4) forms at your own home/work at your convenience and bring it to the office to save time before being interviewed by our medical professional.
2, You can just walk in and ask for the "forms" at the front desk personal ( Filling up the forms will take you extra 15-20 minutes of your time)
Please Print, Fill up and sign the forms attached below before receiving any treatment for any Dermal Fillers treatments such as Juvederm, Restylane or Radiesse. (This will save you time) if you do not do so, then it will be filled in the medical office. You can call us for any question /concern
Please note that receiving injectables such as Dermal Fillers such as Juvederm, Restylane, Belotero, and Radiesse are medical procedures performed by trained medical professional ( Medical Doctors (MD) and Nurse Practitioners (NP) ) and requires proper documentation of the patient Medical History, signed Patient Consent Form, as well as signed Post-Treatment Written Instructions. Before receiving any of these treatments by our medical professionals the patient must provide valid (non-expired) US ID (Identification) ( State Driver License, Passport Card or any other Government-authorized form). All forms must be completely filled and signed by the patient before receiving care.
You can :
1. Print the forms at your own home/work at your convenience and bring it to the office to save time before being interviewed by our medical professional.
2, You can just walk in and ask for the "forms" at the front desk personal ( Filling up the forms will take you extra 15-20 minutes of your time)
Please Print, Fill up and sign the forms attached below before receiving any treatment for any PRP treatment. (This will save you time) if you do not do so, then it will be filled in the medical office. You can call us for any question /concern
Please note that receiving PRP treatment in any part of the body is a medical procedure performed by trained medical professional ( Medical Doctors (MD) and Nurse Practitioners (NP) ) and requires proper documentation of the patient Medical History, signed Patient Consent Form, as well as signed Post-Treatment Written Instructions. Before receiving any of these treatments by our medical professionals the patient must provide valid (non-expired) US ID (Identification) ( State Driver License, Passport Card or any other Government-authorized form). All forms must be completely filled and signed by the patient before receiving care.
You can :
1. Print the forms at your own home/work at your convenience and bring it to the office to save time before being interviewed by our medical professional.
2, You can just walk in and ask for the "forms" at the front desk personal ( Filling up the forms will take you extra 15-20 minutes of your time)
Please Print, Fill up and sign the forms attached below before receiving any treatment for any Peptide Therapy treatments. (This will save you time) if you do not do so, then it will be filled in the medical office. You can call us for any question /concern
Please Print, Fill up and sign the forms attached below before receiving treatment for PDO Threads (This will save you time) if you do not do so, then it will be filled in the medical office. You can call us for any question /concern
Please Print, Fill up and sign the forms attached below before receiving treatment for Sclerotherapy (Asclera) (This will save you time) if you do not do so, then it will be filled in the medical office. You can call us with any question /concern
Please Print, Fill up and sign the forms attached below before receiving treatment for Chemical Peelings (Illuminize, Vitalize or Rejuvenize (This will save you time) if you do not do so, then it will be filled in the office. You can call us with any question /concern
Please Print, Fill up and sign the forms attached below before receiving treatment for BIO-Identical Hormone Replacement Therapy . Please be aware that Males and Females have different forms , so please pick the one according to your gender. (This will save you time) if you do not do so, then it will be filled in the office. You can call us with any question /concern
Please Print, Fill up and sign the forms attached below before coming for PrEP exposure prophylaxis for HIV. (This will save you time) if you do not do so, then it will be filled in the office. You can call us with any question /concern
Please Print, Fill up and sign the forms attached below before coming for Morpheus 8 . (This will save you time) if you do not do so, then it will be filled in the office. You can call us with any question /concern
Please Print, Fill up and sign the forms attached below before coming for Primary Care/ General Internal Medicine. (This will save you time) if you do not do so, then it will be filled in the office. You can call us with any question /concern