Patient Forms

To save time on the day of your appointment, please fill out these forms and bring them with you:

• Patient Information Sheet
• Gallacher Medical History Form
• Cosmetic Interest Questionnaire
• Notice of Privacy Practices
• Acknowledgement of Financial Responsibility
• Consent to the Use & Disclosure of Health Information
• Arbitration Agreement
• Credit Card Authorization and Collections Acknowledgment
• Assignment and Release/Use and Disclosure of Health Information