Patient Forms

General Forms

• Authorization for Medical Treatment and Financial Responsibility 
• Authorization for Release of Records 
• CPAP Instructions 
• General Health Questionnaire 
• Health History 
• Health Questionnaire 
• Media Authorization Form
• New Patient Questionnaire 
• Outpatient Preoperative Instructions  
• Preoperative Instructions for Outpatient Surgery 
• Preoperation Instructions for Surgery 

For Patients of Dr. Ida Fox

• Authorization for the Use or Disclosure of Protected Health Information 
• Health Questionnaire 
• Preoperative Instructions 

For Patients of Dr. Susan Mackinnon

• CAM Preoperative Instructions 
• CPAP Instructions 
• Pain Questionnaire  
• Patient Health Survey 
• SF-8 Health Survey
• Six Pages: Secret to Losing Weight 

For Patients of Dr. Thomas Tung

• Preoperative Instructions for Outpatient Surgery 

For Resident Cosmetic Clinic Patients

• Important Facts 
• Preoperative Instructions for Surgery

Patient Care Instructions

• Care of Cast  
• Care of Nipple Tattoo