Cosmetic Practice Forms

Cosmetic practice and surgery forms, patient intake forms, post op instruction guides, pre-op guides, botox, restylane, personal history, routing slip, superbill, super bill, patient history, patient sign in, botox consent form, new patient, new client, photography release, video release, interview release forms, and more.

$58.50 $36.45

A more complete, 3 page, Restylane®, facial injections consent form. Patient authorizes physician to perform Restylane injections into muscles covering patient's forehead, face, chewing muscles, scalp, neck, or upper back, it also informs of risks and alternative treatments.

It is divided into several sections, Instructions; Introduction, what Restylane is, what it has been approved for, and general information about the effects; Alternate Treatments; Risks of Restylane; Normal Occurrences During Tissue Filler Injections, Including Restylane; Complications and Health Insurance.

With its contemporary design and host of features, it is sure to enhance any cosmetic practice or existing medical or doctor's office wanting to do away with their old patient intake forms and replace them with new, updated, contemporary forms without going through the expense of new form typesetting and offset printing fees. Print as many as you need and edit them as your office needs change in time.


$22.50 $20.25

A correspondence form to assist in communication and the sharing of information between patient and doctor is important piece. Each phone call, letter, or email is a piece of your patient's story. Sometimes, questions or disputes may arise, and documentation is independent evidence that can clarify details, and help avoid future confusion and misunderstandings.

You may print just a few, as needed, or take the artwork to your local print shop for quantity printing and drilling of holes on top of page.


$112.50 $32.00

This Planning for Cosmetic Surgery brochure is a great planning toolkit and a helpful resource to answer your patient's general questions and address basic information that may be relevant to their plastic surgery experience. Patient safety should be your highest priority and informing your patients will be your biggest asset. Teaching your patients about their options will help them be educated patients, better prepared for physician consultations and ready to decide on which procedure is right for them.

This is a great brochure and editable using Microsoft Word. Easy to personalize, once completed, print, in your office, as many as needed, or deliver camera-ready artwork to your local speedy printer or print shop, for quantity brochure printing.


$40.50 $28.35

This is a Restylane® Fee Schedule (or for any other type of dermal filler or any type of procedures where you wish to have a price list), includes procedures, prices, payment schedule and signature line for client. May also be used as a fee schedule form for types of surgical procedures, easily edit and change form fields to best meet your needs. May be used as is, or easily personalized using compatible word processor.

With its contemporary design and host of features, it is sure to enhance any cosmetic practice or existing medical or doctor's office wanting to do away with their old patient intake forms and replace them with new, updated, contemporary forms without going through the expense of new form typesetting and offset printing fees. Print as many as you need and edit them as your office needs change in time.


$40.50 $26.00

This release form is used to obtain client photography and interview permission and includes rules by which patient/client must agree to abide in exchange of value received to client/doctor. Protect yourself if you will be taking photographs and/or will be using any other patient material for any type of purpose, be sure to have your client's permission in writing.

With its contemporary design and host of features, it is sure to enhance any cosmetic practice or existing medical or doctor's office wanting to do away with their old patient intake forms and replace them with new, updated, contemporary forms without going through the expense of new form typesetting and offset printing fees. Print as many as you need and edit them as your office needs change in time.


$31.50 $20.25

A medical release form is a document that gives healthcare professionals permission to share patient medical information with other parties. Patient's must first sign a release.

According to the U.S. Department of Health and Human Services, “An authorization is a detailed document that gives covered entities permission to use protected health information for specified purposes, which are generally other than treatment, payment, or health care operations, or to disclose protected health information to a third party specified by the individual.” 

Did You Know? Verbal medical release agreements are not sufficient because they are impossible to verify if there’s ever a disagreement. Healthcare staff need a written copy on record with a signature to protect themselves. If you are ever instructed to share healthcare information on behalf of a patient, make sure you have them sign a release form.


$58.50 $36.45

A welcome form, sure to impress your clientele upon receiving it. Learn more about your own clients by obtain information as to the primary reason why they are visiting your cosmetic practice, why they selected your practice and also inquires about other cosmetic procedures they may be interested in being informed and their preferred payment option(s). Easily edit the form to your particular questions using Microsoft Word or other compatible word processor.

With its contemporary design and host of features, it is sure to enhance any cosmetic practice or existing medical or doctor's office wanting to do away with their old patient intake forms and replace them with new, updated, contemporary forms without going through the expense of new form typesetting and offset printing fees. Print as many as you need and edit them as your office needs change in time.


$22.50 $20.25

Pre treatment instructions for Restylane® treatment, leaflet with instructions for patients who will be receiving Botox injections. What to expect, what to do prior to treatment, what to do 24 to 48 hours before treatment, additional recommendations and notice of who should not be treated with Restylane. To avoid legal issues be sure you patient is well informed, before and post treatment.


$49.50 $28.35

Botox Treatment Consent Form. Patient authorizes physician to perform cosmetic treatment and is disclosed information concerning Botox, how it injected, side effects, what to expect, patient also acknowledges the limitations of Botox treatments and possible side effects and dangers. Patient consent date and signature signature lines at bottom of form. Physician should examine form to see if it may benefit his/her practice to help keep patients legally informed.


$40.50 $36.45

General Restylane®, facial injections consent form. Patient authorizes physician to perform Restylane injections into muscles covering patient's forehead, face, chewing muscles, scalp, neck, or upper back. Form may be modified or edited to meet your own practice needs and or other types of fillers and treatments.

With its contemporary design and host of features, it is sure to enhance any cosmetic practice or existing medical or doctor's office wanting to do away with their old patient intake forms and replace them with new, updated, contemporary forms without going through the expense of new form typesetting and offset printing fees. Print as many as you need and edit them as your office needs change in time.


$22.50 $20.25

Provide your clients and customer with a welcoming letter showing that you respect their rights to dignity and pride with the Patient's Rights notice / handout.

This document will explain your patient rights and responsibilities. It is part of your patient's registration and is an important part their health care. Our commitment to your patients should include and inform them of their rights and responsibilities. This notice complies with applicable Federal civil rights laws and affirm that the clinic will deliver high-quality health care to every patient


$40.50 $28.35

General Restylane® post-treatment guidelines will help to help your patients to adequately prepare after the treatment. Avoid emergencies and legal issues, be sure that your patients leaves your office with post-treatment instructions to follow by providing them with this form and keep an office copy. Easily edit the form to your particular instructions using Microsoft Word or other compatible word processor.

With its contemporary design and host of features, it is sure to enhance any cosmetic practice or existing medical or doctor's office wanting to do away with their old patient intake forms and replace them with new, updated, contemporary forms without going through the expense of new form typesetting and offset printing fees. Print as many as you need and edit them as your office needs change in time.


$112.50 $36.45

Avoid malpractice suits that can tarnish the physician's reputation and raise malpractice insurance premiums by having your client accept binding arbitration of any dispute, avoiding the client's right to a trial.


$34.20 $22.68

Medical Practice Surgery Cancellation Policy, provides information regarding the physician's surgery scheduling and rescheduling policy. It covers areas for scheduling an in-office procedure, scheduling surgery, rescheduling surgery can cancelling surgery, plus fees associated. Acceptance date and signature lines at bottom of form.


$40.50 $36.45

Botox Therapy Consent Form. Patient authorizes physician to perform Botox injections and is informed of all that is related to the procedures such as the proposed treatment, anticipated benefits, risks and complications associated with treatment, Botox limitations and alternatives, costs/fees, follow ups, photographs, etc. Consent signature is at bottom and patient consents that all above questions have been answered and accepts the risks and complications of the procedure.

No need to design your form from scratch, with its contemporary design and host of features, it is sure to enhance any cosmetic practice or existing medical or doctor's office wanting to do away with their old patient intake forms and replace them with new, updated, contemporary forms without going through the expense of starting from a new form or form typesetting and offset printing fees. Print as many as you need and edit them as often as needed.


$40.50 $36.45

General botox, facial injections consent form. Patient authorizes physician to perform Botox injections into muscles covering patient's forehead, face, chewing muscles, scalp, neck, or upper back. Form may be modified or edited to meet your own practice needs.


$37.80 $34.02

This form recognises that there are patients, members of the community who cannot speak English, and others that have other communication needs. This translation statement is intended to ensure that measures are in place across the office to support communication with everyone whose first language is not spoken english, does not communicate by the spoken work or has any form of communication difficulty.

The form acknowledges that the health care or interpreter has explained the procedure or course of treatment to the patient to the best of his/her ability and acknowledges that he/she believes the patient has understood. Signature and date lines for patient and interpreter.

Protect your rights, be sure non English speaking patients have had all procedures explained, what procedure is likely to involve, including risks, alternative treatments, including no treatment and any particular concerns to patient and that he/she fully understood, avoid legal issues along the way.

Did You Know?  Responsibility for arranging translation or interpreting services lies with the organisation and not the service user.


$31.50 $22.00

This New Client Information form can be used to obtain patient information as an intake or registration form. Its contemporary and clean design makes it easy for clients/patients to read and answer the questions. May be used as is, or easily editable using Microsoft Word to assist you in asking only the questions that you wish to obtain from your patients.

With its contemporary design and host of features, it is sure to enhance any cosmetic practice or existing medical or doctor's office wanting to do away with their old patient intake forms and replace them with new, updated, contemporary forms without going through the expense of new form typesetting and offset printing fees. Print as many as you need and edit them as your office needs change in time.


$40.50 $28.35

General cosmetic surgery preoperative and post-operative guidelines will help to help your clients and patients to adequately prepare ahead of time. Avoid emergencies and legal issues, be sure that your patients follow your exact pre-op and post-op instructions. Easily edit the form to your particular questions using Microsoft Word or other compatible word processor.

With its contemporary design and host of features, it is sure to enhance any cosmetic practice or existing medical or doctor's office wanting to do away with their old patient intake forms and replace them with new, updated, contemporary forms without going through the expense of new form typesetting and offset printing fees. Print as many as you need and edit them as your office needs change in time.


$40.50 $20.25

Proper, specific, and reproducible labeling of anatomic locations of dermatologic lesions or therapy is important to record as part of a patient's medical history.  These drawings can serve as a list of locations treated (e.g. with Botox, etc.) proving very useful on patient's next visit.


$40.50 $36.45

A 2 page, Botox®, facial injections consent form. Patient authorizes physician to perform Restylane injections into muscles covering patient's forehead, face, chewing muscles, scalp, neck, or upper back. Form may be modified or edited to meet your own practice needs and or other types of fillers and treatments.


$112.50 $36.45

Avoid malpractice suits that can tarnish the physician's reputation and raise malpractice insurance premiums by having your client accept binding arbitration of any dispute, avoiding the client's right to a trial. For use in California.


$40.50 $24.00

This form is used used to obtain new client or patient, allergy and medication information. It has room for patient's personal information, allergies, medicines, vitamins and other supplements and for any insulin taken and dosage, keep in mind that form fields can be edited using Microsoft Word or other word processor..

With its contemporary design and host of features, it is sure to enhance any cosmetic practice or existing medical or doctor's office wanting to do away with their old patient intake forms and replace them with new, updated, contemporary forms without going through the expense of new form typesetting and offset printing fees. Print as many as you need and edit them as your office needs change in time.


$22.50 $20.25

A patient's guide listing frequently asked questions about Restylane® and Restylane injections, patient handout / leaflet. Easily editable using word processor. 

Put your clients at ease and provide them with Restylane injection information.


$108.00 $52.65

A superbill is a form used by medical practitioners and clinicians so they can quickly complete and submit the procedure(s) and diagnosis(s) for a patient visit for reimbursement. It is generally customized for a provider office and contains patient information, the most common CPT (procedure) and ICD (diagnostic) codes used by that office, and a section for items such as follow-up appointments, copays, and the provider’s signature.

The super bill is bundled with Microsoft Word forms and a fillable PDF form for use with free Adobe Reader. Both forms can be personalized with your practice name, address, contact numbers, etc. The Word form is fully editable, the PDF form you can only edit your practice business name, address, etc.


$108.00 $52.65

A superbill is a form used by medical practitioners and clinicians so they can quickly complete and submit the procedure(s) and diagnosis(s) for a patient visit for reimbursement. It is generally customized for a provider office and contains patient information, the most common CPT (procedure) and ICD (diagnostic) codes used by that office, and a section for items such as follow-up appointments, copays, and the provider’s signature.

Superbills aggregate the data from a patient visit needed to successfully submit an insurance claim. This includes provider information, patient information and visit information. Superbills are different from receipts/invoices because they provide additional information regarding the visit (diagnosis and procedure codes) that are needed to get a claim approved.


$40.50 $28.35

This is a Botox Fee Schedule (or for any other type of dermal filler or any type of procedures where you wish to have a price list), includes procedures, prices, payment schedule and signature line for client. May also be used as a fee schedule form for any other type of surgical procedures, easily edit and change form fields to best meet your needs.

With its contemporary design and host of features, it is sure to enhance any cosmetic practice or existing medical or doctor's office wanting to do away with their old patient intake forms and replace them with new, updated, contemporary forms without going through the expense of new form typesetting and offset printing fees. Print as many as you need and edit them as your office needs change in time.


$49.50 $30.78

The HIPAA Privacy Rule gives individuals a fundamental new right to be informed of the privacy practices of their health plans and of most of their health care providers, as well as to be informed of their privacy rights with respect to their personal health information. Health plans and covered health care providers are required to develop and distribute a notice that provides a clear explanation of these rights and practices. The notice is intended to focus individuals on privacy issues and concerns, and to prompt them to have discussions with their health plans and health care providers and exercise their rights. 

Did You Know? The notice must include an effective date, it is your responsibility to add the effective date. See 45 CFR 164.520(b) for the specific requirements for developing the content of the notice. A covered entity is required to promptly revise and distribute its notice whenever it makes material changes to any of its privacy practices. See 45 CFR 164.520(b)(3), 164.520(c)(1)(i)(C) for health plans, and 164.520(c)(2)(iv) for covered health care providers with direct treatment relationships with individuals. 


$22.50 $20.25

A list of frequently asked questions about Botox and Botox injections, patient handout / leaflet. Easily editable using word processor.


$43.20 $22.68

The form's purpose is to obtain patients signature acknowledging that patient received the HIPAA Privacy Practices Notice.

Did You Know? Under the HIPAA Privacy Rule, the local health department is required to disseminate its Notice of Privacy Practices to all patients upon the first delivery of service after April 14, 2003, and to make a good faith effort to obtain the patient's acknowledgment that he or she has received the Notice.


$31.50 $28.35

This form is used used to obtain new patient medical history. Form is divided into 4 sections. Patient information, past medical history, medications, and the last section is reserved for women only. May be used as is, or easily personalized to your individual needs, using compatible word processor.

No need to design your form from scratch, with its contemporary design and host of features, it is sure to enhance any cosmetic practice or existing medical or doctor's office wanting to do away with their old patient intake forms and replace them with new, updated, contemporary forms without going through the expense of starting from a new form or form typesetting and offset printing fees. Print as many as you need and edit them as often as needed.


$31.50 $20.25

This release form is used to obtain client authorization to take before and after photographs for documentation purposes. It also grants the physician, if agreed by the client, permission to use such photographs in other types of publications.

No need to design your form from scratch, with its contemporary design and host of features, it is sure to enhance any cosmetic practice or existing medical or doctor's office wanting to do away with their old patient intake forms and replace them with new, updated, contemporary forms without going through the expense of starting from a new form or form typesetting and offset printing fees. Print as many as you need and edit them as often as needed.


$49.50 $28.35

Botox® Treatment Consent to Treat a Minor Form. The parent or guardian of a minor, authorizes physician to perform cosmetic treatment and is disclosed information concerning Botox, how it injected, side effects, what to expect, patient also acknowledges the limitations of Botox treatments and possible side effects and dangers. Patient consent date and signature signature lines at bottom of form. Physician should examine form to see if it may benefit his/her practice to help keep patients legally informed and physician from legal problems.


$22.50 $20.25

An office, sign-in register for patients to sign-in when they enter the office. 

Form may be printed in your office and only print the amount you need or may be delivered to your local print shop for quantity printing.


$49.50 $30.78

This form is used provided to client by physician so he can obtain a comprehensive breast history prior to considering breast surgery.

Includes both, sections for written responses and multiple choice using check boxes. Fully edit the questions to your particular practice needs.


$22.50 $20.25

Pre treatment instructions for Botox treatment, leaflet with instructions for patients who will be receiving Botox injections.


$22.50 $20.25

The form is intended to clarity, to client/patient of their financial responsibility with medical services and procedures.


$31.50 $28.35

An Authorization for Disclosure of Health Information is an individual's signed permission to allow a covered entity to use or disclose the individual's protected health information (PHI) that is described in the Authorization for the purpose(s) and to the recipient(s) stated in the Authorization.

The form's purpose is to obtain patients signature to be able to use or disclose health information. 

English and Spanish bundled together.


$49.50 $30.78

This notice describes to your clients and patients how medical information about them may be used and disclosed and how the patient can get access to this information. 

The Health Information Portability and 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 a physician, whether electronically, on paper, or orally, are kept properly confidential. This Act gives the patient, significant new rights to understand and control how their health information is used. HIPAA provides penalties for covered entities that misuse personal health information. This information provided to client or patient is required by HIPAA.


$31.50 $20.00

This release form is used to obtain client authorization to take photographs for use as an aid in patient's treatment. Protect yourself if you will be taking patient photographs, be sure to obtain your client's permission in writing. Form uses industry standard, legal wording section and may be fully edited or modified using Microsoft Word or other word processors.

With its contemporary design and host of features, it is sure to enhance any cosmetic practice or existing medical or doctor's office wanting to do away with their old patient intake forms and replace them with new, updated, contemporary forms without going through the expense of new form typesetting and offset printing fees. Print as many as you need and edit them as your office needs change in time.


$31.50 $28.35

This form is find out what procedure(s) your client is interested in, it contains a multitude of cosmetic practice therapies and procedures. Easy to respond check boxes so client can just check mark the procedures of interest. If is followed by a few more questions concerning the personal opinions the client may have about the procedure and if they had previous cosmetic surgery. Get informed on what your customers wish for.

No need to design your form from scratch, with its contemporary design and host of features, it is sure to enhance any cosmetic practice or existing medical or doctor's office wanting to do away with their old patient intake forms and replace them with new, updated, contemporary forms without going through the expense of starting from a new form or form typesetting and offset printing fees. Print as many as you need and edit them as often as needed.


$31.50 $20.00

A form authorizing the clinic or doctor's office to charge a patient, certain amount of money if the patient misses his/her's scheduled appointment day, unless said patient informs the clinic or doctor, within a certain amount of hours in advance to cancel or make other scheduled appointment.

With its contemporary design and host of features, it is sure to enhance any cosmetic practice or existing medical or doctor's office wanting to do away with their old patient intake forms and replace them with new, updated, contemporary forms without going through the expense of new form typesetting and offset printing fees. Print as many as you need and edit them as your office needs change in time.


$31.50 $28.35

A new patient intake form to help expedite patient's visit and learn about your patients history and reason for visit, with areas to learn more about your patient's other interest in cosmetic procedures. Obtain patient's home and work address, contact & emergency numbers, services requested, areas of cosmetic interest and past cosmetic procedures history, referral, patient signature line, and more. May be used as is, or easily personalized using compatible word processor.

With its contemporary design and host of features, it is sure to enhance any cosmetic practice or existing medical or doctor's office wanting to do away with their old patient intake forms and replace them with new, updated, contemporary forms without going through the expense of new form typesetting and offset printing fees. Print as many as you need and edit them as your office needs change in time.


$18.00 $16.20

Our referral card provides information that is easy to read and understand for you and your referring doctor. Layout is tailored to your practice and the specific services you offer. 

Easily edit using Microsoft Word and print from your office in regular bond paper or thicker stock, print as many as you need. 2 will fit on 8.5" x 11" letter size paper.