Patient Forms

A variety of downloadable forms are provided for your convenience and reference. Please note that the information regarding specific procedures and recovery is intended only for general educational purposes and is not intended to replace or substitute or supersede any instructions of information conveyed to you by Drs. Pelosi and their team which have been specifically tailored to your needs. Similarly, if your surgery was performed elsewhere by another surgeon, do not apply our information to your situation.

General Forms

Patient History Form
This is your opportunity to list pertinent information about your health and any medications, surgeries (including all cosmetic treatments) or illness which you have had in the past. Be as accurate as possible. If you are unsure of any item, leave it blank or add a question mark. This form needs to be completed the first time you visit us. You may print it out and fill  it out at home if you wish & bring it to your visit.

Patient Information Update Form
If you've already had your initial visit with us and are returning as an established patient, this is your opportunity to update us on any changes in your medical history and health.

Authorization - Release of Medical Information Form
This form gives us your permission to send or receive your personal medical information and is required by law before any information can be transmitted.

Preoperative Bloodwork Testing Form
This form lists all of the bloodwork testing required prior to your cosmetic procedure. It is best to have these tests done on an empty stomach at least 8 hours since your last meal, at least 72 hours after any alcohol consumption, and at least 7 days after the ingestion of aspirin, ibuprofen or any other nonsteroidal anti-inflammatory drugs.