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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 lift Removal of cysts, moles, etc FotoFacial RF Face or Neck Lift Collagen/Botox/Restylane Eyelids Scar Revision Liposuction Protruding ears Skin Resurfacing Skin Care Hair Removal Skin Cancer Lip enhancement Other


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

 Yes No

Are you allergic to Latex?*

 Yes No

Any known drug allergies?*

 Yes No