Tell Us Your Story and Vision
Your health is of utmost importance to Illinois Cosmetic and Plastic Surgery. Therefore, to ensure that we have all the needed information to properly care for you, we have several patient information forms for you to complete.
New Patient Registration Forms
Please remember that accuracy and honesty are extremely important when filling out any official paperwork, especially that related to your health. Download and fill out these forms before your appointment to save time!
- Patient Information
- Medical History
- Release Form
- Name/Date of Birth
- (Get Adobe Reader Here!)
Submitting Registration Forms
Although these forms are available online, they are not electronically submitted. Please print completed forms, sign and bring them with you to your appointment.
These forms have been saved in Adobe® Acrobat® for your convenience. They require Version 7.0 or above. A link has been provided below if you are in need of this software. We cannot guarantee the functionality of the software in the link below. We provide this link to you “as is”, and you agree to use it at your own risk.