New Patient Forms

New patient forms are available for your convenience. You may choose to print and complete the forms and bring to your first appointment.

Click the links below to access the forms. There are a total of 6 pages

Patient Information

Medical History

Medication List

Hippa Form


With my consent, Plastic Surgeons of the Hudson Valley may use and disclose protected health information about me to carry out treatment, payment and healthcare operations.  Please refer to the Notice of Privacy Practices for a more complete description of such uses and disclosures.

You have the right to review and obtain a copy of the Notice of Privacy Practice.

Notice of Privacy Practices