We ask all of our patients to provide us with as much information about their previous medical history and goals as possible. This will assist us in creating a tailored program to meet your specific needs. We want to ensure that you have realistic goals about any of the procedures we offer.

If you wish to undergo any image enhancement procedures at the Vérité Esthetic Surgery clinic, you need to complete the following form. You can download it and print it from your home computer to fill out at your convenience.

Answering these questions at home means you won't have to spend valuable time completing the form in our office. If you have any questions about the form, our friendly staff will be more than happy to assist you during your visit.

All forms are in PDF format. If you don't have Adobe Reader, please click the following icon to download this free program:


Please include as much information as possible and bring the completed form during your visit to the Vérité Esthetic Surgery clinic.

Thank you in advance for your cooperation.

Please print out and complete the following required patient form:

Patient Information Form