New Patient and Consent Forms

Please fill out the new patient form if you have not seen us, and consent forms for desired procedure before appointment. You can bring it in on visit date, fax, fax or email to us. Otherwise, simply arrive 30 minutes prior to fill out in office. Thank you!!!

Please print and fill out registration for prior to appointment
PRP Registration form
RegistrationRegenerativePRP.pdf
Adobe Acrobat document [282.2 KB]

Vampire Facelift Consent form
Please print and sign prior to appointment for the Vampire facelift procedure
consent-for-the-Vampire-Facelift-®-proce[...]
Adobe Acrobat document [33.9 KB]

Vampire Breast Lift Consent form
Please print and sign prior to procedure.
Vampire-Breast-Lift®-Consent.pdf
Adobe Acrobat document [78.1 KB]

"O-Shot" Consent form
Please print and sign prior to procedure.
OshotConsentform.pdf
Adobe Acrobat document [61.5 KB]

Priapus Shot Consent form for Men
Please print and sign prior to procedure
PriapusShotConsent.pdf
Adobe Acrobat document [44.5 KB]

Useful Survey's to assist in your care

Female Sexual Function Questionnaire
Please fill this out if you'd like further advise on therapies to treat any sexual concerns
FemaleSexFunctionQuestionaire.pdf
Adobe Acrobat document [16.9 KB]

Erectile Performance Survey
Please fill out if having challenges or concerns in this area.
ED survey.pdf
Adobe Acrobat document [61.0 KB]