Medical Forms

Providing a holistic approach to medicine

Our forms are designed to ensure smooth sailing once you walk through our doors. Please take the time to carefully complete the necessary forms and return them to us either via fax or email.

If you are unclear of what forms you need to download and complete, please contact our Patient Care Coordinator either via telephone or email.

Before you arrive, we want to ensure that we are in sync with you! This form allows us to log your arrival day/time, any specific requirements you may have regarding hotel accommodation and other details regarding your trip.

Please complete this form if you have scheduled a Skype or telephone consultation with our Cosmetic & Reconstructive Surgeon. The form must be signed and returned PRIOR to your consultation.

The Photo Authorization form allows you to decide how we can utilize any photos taken of you before and after your procedure(s). Please read carefully before signing.

We look forward to helping you with your transformation. Kindly complete this form if you have scheduled an appointment for Plastic Surgery services ONLY. The form needs to completed and returned prior to your appointment.

For those of you who have decided to proceed with your cosmetic procedure, this form is to be completed only when you have finalized the costs associated with your procedure. Please carefully read before completing.

You will be spending some time with us and we want you to be happy during your stay. Please complete this form if you are being admitted to our Hospital. It helps us to understand what type of accommodation you require, your meal preferences, flight details etc.

We would like to thank you for choosing to us for your medical care. Please complete and return this form before your first appointment with us.

Credit Card Authorization

In the event you are staying with us and/or are having multiple services rendered, we may ask you to complete this form to authorize us to remove funds from your account to pay for your services. The Accounts Receivable Clerk will discuss this with you before asking you to complete.