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.

New Patient Registration 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

Medical Aesthetic Forms
	Medical Aesthetic Intake Form
	Botox Consent Form
	Intense Pulsed Light (IPL) consent form
	Restylane Consent Form
	Counseling for Eyelid Surgery
	Consent for Surgery
	Consent for Orbital Tumor Removal

Other Forms
	Certificate of Need Form
	Pre-Anesthesia Form

Counseling Sheets
	Surgical Consent - Eyelid
	Surgical Consent - Orbit
	Surgical Consent - Strabismus

Forms Require Free Adobe Reader Software - download here if needed