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