You can save time by downloading and completing these forms in advance - then mail
them to us or bring them with you at your appointment.
For your convenience we have provided our patient history and other forms in a format
that you can download, print, and complete before your appointment. To save time
when you arrive for your appointment, you can mail the completed forms to our office,
or bring them with you at the time of your visit.
Required Forms (marked with *)
Patient History Form
*
Information about your general health and your health history.
Consent To Treatment
Form *
This is your consent to receive treatment at our Center.
Medications List And Acceptance
Form *
Checklist for making your physician aware of your current medications.
The above 3 forms are required. Please complete all three forms and bring them along
on your first visit.
Other Forms
Financial Policy
We strongly believe that an informed patient is a good patient and that your clear understanding of our financial policy is
important to our professional relationship.
Records Release Form
Gives us permission to communicate with your insurance and other health providers.
Criteria
For Breast Reduction
Document describing conditions for breast reduction.
Patient Satisfaction
Survey
Tell us what you liked (or did not like) about your experience at Hickory Plastic
& Reconstructive Surgery Center, and how we can serve you better.
All of our download forms and documents require the Adobe Acrobat reader, which
most of you will already have.
Download the free Adobe Acrobat reader.