New Patient Forms



Our staff looks forward to meeting you and discussing your reconstructive, restorative, or cosmetic surgery goals. We strive to keep our appointments on time, as scheduled. Prior to your appointment, we encourage you to fill out the patient forms that are located on this website so that you can accelerate your check-in process. Please download, save your form, fill it out and upload to your patient portal. If you have any issues we ask that you call our office. Due to the Covid-19 outbreak we are trying to keep everyone safe and this means we will need to do all paperwork online and through MyPatientVisit the online portal.

Patient Demo SheetOnline Registration PaperworkBreast Reconstruction Questionnaire



By signing the Privacy Practices Consent in your Online registration paperwork, you are acknowledging and agreeing that you have reviewed the Notice of Privacy Practices, found below, in its entirety. If you have any questions about any of these forms, or our privacy practices, please contact our office. The ‘Notice of Privacy Practices’ is for you to keep. It does not need to be returned to the office.

Notice of Privacy 2020



Please complete and return the Medical Records Release Form if you are requesting a copy of your records. This form is required at all times in order to release records to anyone other than your medical team. You may choose to pick up a hard copy of your records in person or have them mailed to you. Electronic copies via email are not available. If additional photo or media releases are needed those forms are available below as well.

Medical Records ReleaseMedia Release FormPhoto ReleasePHI