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Patient Forms

Prior to your first appointment, download, print and fill out the “New Patient Package” consisting of three forms: Registration, Medical History and Signature on File. This will save you valuable time and make for complete information, as some information required will most likely be in your records at home.

If you need help with any paperwork, please do not hesitate to ask a member of the staff for assistance.

Forms are provided in Adobe Acrobat PDF format. If you do not have Adobe Reader, click on the link below to download Acrobat Reader free-of-charge.

 New Patient Package (includes 3 forms below)


Medical History

Signature on File

 Auto Accident - No-Fault

 Work Injury - Workers Compensation

 Sun Block

 Post Operative Instructions

 ER - Consent

 Request for Release of Information




(c)  2005 Associated Plastic Surgeons

864 Jericho Tpke . West Hills . New York 11743

Contact Us 

 (631) 423-1000