“Hola, soy Gary Gibson. Soy una persona afortunada al llamar a la Dra. Anna Rosinska, mi médico y mi amiga. Ella y su personal han sido una gran bendición tanto para mi familia como para mí.Formularios para pacientes
For your (and our) convenience several Patient Forms are enclosed, so you can print and fill them out before your appointment. It’ll save time at the office and already be done. Thank you!
Section A: Medical Visits
For patients interested in Bio-Identical Hormone Treatment
- Bio-Identical Hormone Treatment Consent Form
- Hormonal Imbalance Quiz for Women
- Hormonal Imbalance Quiz for Men
For Patients interested in detailed Skin Exam & Evaluation
If you’d like us to obtain your medical records from another physician before your first appointment with us, please print out sign and fax back this form to:
(432) 684-7049 as soon as possible.
Section B: Aesthetic/Weigh Loss/Laser/Facial Treatments
If you know what procedure that you are interested in, please select the appropriate Consent Form in addition to the above New Patient Form.
- Botox Consent Form and Instructions
- Chemical Peel & Jet Peel Consent Form
- Dermal Fillers Consent Form
- hCG Diet Consent Form
- Mesotherapy Consent Form and Instructions
- Microdermabrasion Consent Form
- Laser Hair Removal Consent Form
- Laser Vein Treatment Consent Form
- Laser Pigment Removal Consent Form
- Laser Tattoo Removal Consent Form
- Liquid Facelift Consent Form (COMING SOON!)
- Lipotron/Lipoplasty Consent Form
- Permanent Cosmetics Consent Form (COMING SOON!)
- PhotoDynamic Therapy (PDT) with Levulan Consent Form
- PhotoFacial (IPL) Consent Form
- RF Facelift (Skin Tightening) Consent Form (COMING SOON!)
- Sclerotherapy Consent Form
- SmoothBeam Laser (Scar & Wrinkles) Consent Form
- WelaSmooth Consent Form and Instructions
Section C: Skin Care Consultations
We greatly appreciate you helping out and filling out these forms early. Thank you and see you soon!