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Patient forms

Paperwork, finished
before you arrive.

Completing forms at home means your consultation time is spent talking with the surgeon, not filling in boxes.

Download

01 · Save the forms you need

Print and complete

02 · Fill in by hand, in ink

Bring to your visit

03 · Or send ahead securely

Available forms

Everything you will
be asked to sign.

New patients need the first five. Pre-operative instructions are issued once a procedure is scheduled.

  • New patient registration

    Contact details, emergency contact, and how you heard about the practice.

    PDF · 2 pages

    Download
  • Medical history questionnaire

    Conditions, prior surgeries, medications, supplements, and allergies. Please be thorough; it directly affects surgical safety.

    PDF · 4 pages

    Download
  • Photography consent

    Permission for clinical photographs used in planning and, optionally, for anonymized educational use.

    PDF · 1 page

    Download
  • Notice of privacy practices

    How your health information is used and protected. Acknowledgment of receipt.

    PDF · 3 pages

    Download
  • Financial policy

    Consultation fees, surgical deposits, cancellation terms, and accepted payment methods.

    PDF · 1 page

    Download
  • Pre-operative instructions

    Provided once surgery is scheduled: medications to pause, nicotine cessation, fasting, and what to bring.

    PDF · 2 pages

    Download

Form names and descriptions are sample content. No PDFs are attached in this preview; download buttons are visual placeholders.

Need help with a form?

Call the office and a coordinator will walk you through it, or arrive fifteen minutes early and complete it with us.

Call (203) 838-8844

Next step

Forms done?
Book the visit.

Request a private consultation and bring your completed paperwork along.

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