Follow the steps to complete the Patient Intake Form online.

1. Press the ‘Get Form’ button to access the Patient Intake Form and open it for editing.
2. Begin by entering your personal information. Provide your full name, date of birth, and preferred name, ensuring accuracy as this information will be vital for your records.
3. Next, fill in your contact details. This includes your home, work, and cell phone numbers, as well as your email address. Specify your preferred contact number.
4. Indicate your marital status and occupation, along with your employer’s name and address. This helps establish your profile within our systems.
5. List your primary care physician's name and how you heard about the institute. If recommended by someone, include their name.
6. Select the services you wish to discuss, including various cosmetic procedures. This assists us in preparing for your consultation efficiently.
7. Provide details of your skincare concerns and your timeframe for surgery, if applicable. This information helps us tailor our recommendations.
8. Complete the medical history section carefully. List any chronic conditions, past surgeries, drug allergies, and any medications you are currently taking.
9. If applicable, fill out the section for women regarding pregnancy or related health issues.
10. Sign the form to authorize the release of your information to healthcare providers involved in your care, ensuring your privacy is maintained.
11. Review the entire form for accuracy. Once satisfied, save your changes and you can download, print, or share the completed form as needed.

Complete your Patient Intake Form online today to begin your journey at the Bitar Cosmetic Surgery Institute.