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.
New Patient Form – Click Here To Open
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.
Surgery Deposit Policy- Click Here To Open
This form explains our payment and cancellation policies prior to undergoing surgery.