New Patient Forms | We'll Help You Get the Look You Want

New Patient Documents

Welcome to Ditesheim Cosmetic Surgery!

To help you prepare for your appointment more easily, Dr. Ditesheim has made our new patient forms available here for you. Please complete and print your forms bring them with you to your consultation.

• • New Patient Registration Form
  • Consultation Questionnaire
  • Medical History Form

These forms require Adobe Reader for proper viewing. Feel free to call us with any questions you may have before your consultation. We look forward to meeting you soon!

You may also fax (704) 542-8696, scan and email, or attach your forms in email to frontdesk@empowermd.com.