Downloadable Forms

Wellness Patient

Registration/Demographic Information

Medical History Form

Patient Privacy Information Authorization

Notice of Privacy Practices & Receipt

Aesthetic Client

New Cosmetic Client Welcome Letter

Medical History

Fitzpatrick Skin Type Assessment

Skincare Intake Form

Medical Release

Medical Release Consent Form

Use the above form when requesting your records from Perlis MedSpa and Wellness Center.

Medical Release Consent Form - EXTERNAL

Use the above form when requesting your records from another Provider's office to be transferred to Perlis MedSpa and Wellness Center. Complete the form and submit to the office of the Provider you are seeking the records from.