Registration Forms

Click on the forms below to download and print out.
After you complete the forms, you can do one of the following:

  • Bring along with you to your scheduled appointment
  • Fax to: 570-523-9165
  • Scan and email it to patientinfo@lewisburgplastic.com OR administrator@lewisburgplastic.com
Authorization For Exam Form

 

Medical/Surgical History

 

HIPAA Acknowledgement Form