Patient Resource Center
Visit Intake Forms
New Patient Forms
- New Patient Welcome Letter (pdf)
- Registration/ Demographic Information (pdf)
Returning Patient Forms
(Please complete the following forms if your last visit has been over 12 months ago)
- Registration/ Demographic Information (pdf)
- Medical History Form (pdf)
New Aesthetic Client Forms
- New Cosmetic Client Welcome Letter (pdf)
- Medical History (pdf)
Aesthetic Treatment FAQ Forms
- Chemical Peel Treatment Questions(pdf)
- Laser Genesis Treatment Questions(pdf)
Educational Links
- Natural Hormones
- Thyroid Disease/Holistic Medicine
Medical Release Forms
- Medical Release Consent Form (pdf)
- Use the above form when requesting your records from Perlis Wellness Center.
- Medical Release Consent Form - EXTERNAL(pdf)
- Use the above form when requesting your records from another Provider's office to be transferred to Perlis Wellness Center. Complete the form and submit to the office of the Provider you are seeking the records from.