Plastic Surgery Intake & Information Forms

Spend less time in the waiting room by printing and filling out the following four forms.

All forms are in PDF format; you will need Acrobat Reader (a free software)
to view and print them.
» Download Adobe Acrobat

Forms

Patient Information Form

This form details your personal information
and medical history.
» Download

Patient Record of Disclosure

This form tells us how best to contact you
and protect your privacy.
» Download

Notice of Privacy Practices

This form details how we handle your medical records and your
rights concerning these records.
» Download

Acknowledgment of Privacy Practices

This very simple form ensures that you have received and read
Dr. Green's Notice of Privacy Practices (the above form.)
» Download

Member of the American
Society of Plastic Surgery

Member of the American Society
For Aesthetic Plastic Surgery
The Mark of Distinction
In Cosmetic Plastic Surgery

Our Private Operating Room
Has the Highest Level "Class C"
Accreditation from the AAASF

James Green, MD
Plastic Surgery Santa Fe/Albuquerque, New Mexico

The Physician's Plaza, 1631 Hospital Drive, Suite 150
Santa Fe, New Mexico 87505-7670

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