Medical History Forms

You can accelerate your check in process by downloading, printing and completing the forms below before you have your first visit to our reconstructive and cosmetic surgery office in Saratoga Springs.

These forms must be printed and completed by hand and cannot be transmitted electronically. If you wish to send these forms to our office in advance of your first visit, we strongly recommend that you use a shipping method with tracking, such as FedEx, UPS, or DHL. All forms should be mailed to 72 Railroad Place, Saratoga Springs NY 12866.

Printable Forms

Click the links below to download each form.

Health History

Payment Policy


Acknowledgement of Privacy Practice

(Read the Notice of Privacy Practice.)


Main Background

Color Scheme