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Patient Forms

Please download, print and complete the forms provided. These forms are critical for your appointment with Dr. Cockerham. We have provided these patient tools to better guide you through your appointment and process your paperwork faster.

Medical Forms

Patient Registration
Patient Profile Form
Patient Medical History Form
Medical Records Release Form
Summary of Privacy Policy
Cancellation Policy
Payment and Insurance Policy
Acknowledgement of Responsibility of Payment
Certificate of Need Form
Pre-Anesthesia Form
Consent for Orbital Tumor Removal

Aesthetic Forms

Medical Aesthetic Intake Form
Botox Consent Form
Intense Pulsed Light (IPL) consent form
Restylane Consent Form
Radiesse Consent Form
Pre/Post Laser Hair Removal
Consent for Surgery
Pre Treatment Active FX
Post Treatment Active FX
Pre/Post Op Blepharoplasty
Pre/Post Op Liquid Face Lift (BOTOX & Dermal Fillers)

Pre-Post Operative Instruction Forms

Oculoplastics Post-op Instructions
Eyelid Surgery Pre-Post Op Instructions
Strabismus Pre-Post Op Instructions
Post-operative Instructions for Dacrocystorhinostomy (DCR)
Medications That Contain Aspirin
Post-Operative Intense Pulsed Light (IPL)
Active FX Aftercare Instructions
Post-treatment check-list Restylane
What to expect? Radiesse Injection
Pre/Post Laser Hair Removal

Forms Require Free Adobe Reader Software - download here if needed