Cosmetic & Facial Plastics New Patient Forms

Paperwork for Cosmetic Procedures, Facial Plastics, or Reconstructive Surgery

We offer a few options for patients to submit their cosmetic intake form. Please see below.

  • Print and fax: Print the Cosmetic Intake Form fill out, and sign. Once you’re done, please fax these forms to 310-204-4474.
  • Email: Download the Cosmetic Intake Form, fill out, and sign. Once you’re done, please email
  • Fill out the forms online: Fill out and sign the form online. You can complete the online intake forms below and once you’re done, click ‘submit’ and it will automatically send to our team.
  • Drop off at your visit: Print, fill out, and sign the Cosmetic Intake Form and bring the completed forms to your appointment.

1301 20th Street Suite 510
Santa Monica, CA 90404

3831 Hughes Avenue Suite 704
Culver City, CA 90232


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