Welcome to the Aesthetic Plastic Surgery Center
In order to facilitate your registration process and to make your visit to see us more convenient, you may download and complete your registration, medical history, and notice of privacy practices forms before your first visit.
For returning patients download and complete individual forms as needed.
- Registration Form
- History & Physical
- HIPAA Form & Acknowledgement
- Photography Consent Form
- Office Policies
HIPPA & PRIVACY POLICY
NOTICE OF PRIVACY PRACTICES (MEDICAL)
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
The Health Insurance Portability & Accountability Act of 1996 (“HIPAA”) is a federal program that requires that all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally, are kept properly confidential. This Act gives you, the patient, significant new rights to understand and control how your health information is used. “HIPAA” provides penalties for covered entities that misuse personal health information.