Aesthetic Practice Patient Forms

Completing these forms in advance will help shorten your wait time at the office. It may not be necessary for you to complete all forms, please check with Dr. Blanchar's office to determine which forms you will need.

 

Please fax, email or bring the completed forms with you to Dr. Blanchar's office

 

Below is a list of forms that can be downloaded and printed. (The forms are in .pdf format - if you don't have Acrobat's .pdf reader, you can download it here).

General Forms
New Patient [English]
Medical History
Records Release Form
Cosmetic Interest Questionnaire

Consent Forms
Botox Cosmetic/Dysport/Xeomin Consent Form
Juvederm/Restylane/Perlane/Belotero/Voluma XC Consent Form
Laser Consent Form
Photo Consent Form
Radiesse Consent Form
Sculptra Consent Form

New Patient Forms (Other Languages)
New Patient [Danish]
New Patient [French]
New Patient [German]
New Patient [Italian]
New Patient [Serbo-Croation]
New Patient [Spanish]
New Patient [Swedish]
New Patient [Turkish]

What we offer

Services

Location
Bayview General Medicine
4401 West Tradewinds Avenue, Third Floor
Fort Lauderdale, FL 33308
Phone: 954-776-6992
Fax: (954) 776-6969
Office Hours

Get in touch

954-776-6992