Plastic Surgery Consultation Intake Form

Streamline Your Plastic Surgery Consultations with Paperform

Running a successful plastic surgery practice means delivering exceptional patient care from the very first touchpoint. This Plastic Surgery Consultation Intake Form helps you gather comprehensive patient information, understand procedure interests, assess medical clearance requirements, and discuss financing options—all before the patient walks through your door.

Why This Template Works for Plastic Surgery Practices

New patient consultations are the foundation of your practice's success. This template is designed specifically for cosmetic and reconstructive surgeons who need to:

• Understand patient goals and expectations before the consultation begins
• Screen for medical contraindications early in the process
• Collect before photos securely for consultation planning and records
• Present financing options to remove cost barriers and improve conversion
• Save valuable consultation time by having all essential information ready

The form captures everything from basic demographics and contact information to detailed medical history, current medications, procedure interests, and aesthetic goals. Conditional logic ensures patients only see relevant follow-up questions based on their answers, creating a smooth, personalized experience.

Perfect for Modern Aesthetic Practices

Whether you're a solo practitioner or part of a multi-surgeon practice, this template adapts to your workflow. Use it for facial procedures (rhinoplasty, facelifts, blepharoplasty), body contouring (liposuction, tummy tucks, Brazilian butt lifts), breast surgery (augmentation, reduction, lifts), or non-surgical treatments (injectables, laser treatments).

The professional, on-brand design reassures patients that they're working with a premium practice, while the mobile-friendly format makes it easy for them to complete the form at their convenience—whether they're at home researching options or commuting to work.

Automate Your Patient Journey with Stepper

Once a patient submits this form, you can use Stepper to automatically trigger your next steps: send a personalized welcome email, create a patient record in your practice management system, notify your consultation coordinator, or add the patient to a pre-consultation nurture sequence. These automations ensure no lead falls through the cracks and every patient feels valued from day one.

HIPAA Compliance Considerations

Please note that while Paperform offers SOC 2 Type II compliance and robust security features, it is not a HIPAA-compliant solution. For practices that require HIPAA compliance for protected health information (PHI), we recommend using this form for initial inquiry and scheduling purposes, then transferring sensitive medical information to your HIPAA-compliant practice management system during the in-person consultation.

Start Converting More Consultations Today

Get this template working for your practice in minutes. Customize the questions, add your branding, embed it on your website, and start capturing high-quality consultation requests that convert to booked procedures.