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Resource Center

New Patient Forms

Historical Data Sheet

Patient Name *

Which surgical procedure(s) are you interested in?

Rhinoplasty (nose)Forehead liftRemoval of cysts, moles, etcFotoFacial RFFace or Neck LiftCollagen/Botox/Restylane EyelidsScar RevisionLiposuctionProtruding earsSkin ResurfacingSkin CareHair RemovalSkin CancerLip enhancementOther


Have you consulted another doctor in regards to this type of surgical procedure?


Are you allergic to Latex?*


Any known drug allergies?*


A note to our "injectable" (toxin and filler) patients,

Thank you for visiting Rejuvenis Beauty. At Rejuvenis Beauty, patient satisfaction is our first priority. We appreciate your confidence in us, and to our returning patients, your loyalty. To ensure we meet your scheduling needs in this time of higher than usual demand for appointments with Dr. Russo, we ask patients to schedule future appointments well in advance. For our returning patients we recommend you schedule your next appointment at the end of your appointment while checking out.