Patient Forms

Welcome to our patient forms page! Here you can find links to common forms used at New Image Plastic Surgery. Once the form opens, please complete the entire document and click “SUBMIT” and your information will be passed over to our staff ahead of your next visit to our office. Let us know if you have any questions or need to speak with someone about a different submission process.

 Please note that prices may vary depending on the surgeon.

New Patient Form – Click Here To Open

PDF Version of the New Patient Form

Please completely fill out this document to pass over your details, medical history, and emergency contact information.

Facial Patient History and Physical – Click Here to Open

Release of Medical Records – Click Here To Open

This form gives us consent to receive your previous medical history and notes or to send out your medical information to other providers.

Patient Photography & Video Consent & Release – Click Here To Open

This release gives us consent to use your likeness and results from our practice on our website or marketing materials.

HIPAA Information and Consent – Click Here To Open

This consent form informs you of our privacy practices for your protection within the practice.

No-Show Policy – Click Here to Open