Patient Forms

For your (and our) convenience several Patient Forms are enclosed, so you can print and fill them out before your appointment. It’ll save time at the office and already be done. Thank you!

Section A: Medical Visits

New Patient Forms for Dermatology and Medicine

For patients interested in Bio-Identical Hormone Treatment

Bio-Identical Hormone Treatment Consent Form

Hormonal Imbalance Quiz for Women

Hormonal Imbalance Quiz for Men

For Patients interested in detailed Skin Exam & Evaluation

Skin Questionnaire

If you’d like us to obtain your medical records from another physician before your first appointment with us, please print out sign and fax back this form to: 432-688-1900 as soon as possible.

Request for Records Release

Section B: Aesthetic/Weigh Loss/Laser/Facial Treatments

New Patient Forms for Aesthetic Procedures

If you know what procedure that you are interested in, please select the appropriate Consent Form in addition to the above New Patient Form.

Botox Consent Form and Instructions

Chemical Peel & Jet Peel Consent Form

Dermal Fillers Consent Form

hCG Diet Consent Form

Mesotherapy Consent Form and Instructions

Microdermabrasion Consent Form

Laser Hair Removal Consent Form

Laser Vein Treatment Consent Form

Laser Pigment Removal Consent Form

Laser Tattoo Removal Consent Form

Liquid Facelift Consent Form (COMING SOON!)

Permanent Cosmetics Consent Form (COMING SOON!)

PhotoDynamic Therapy (PDT) with Levulan Consent Form

PhotoFacial (IPL) Consent Form

RF Facelift (Skin Tightening) Consent Form (COMING SOON!)

Sclerotherapy Consent Form

SmoothBeam Laser (Scar & Wrinkles) Consent Form

WelaSmooth Consent Form and Instructions

Section C: Skin Care Consultations

New Patient Forms

Skin Questionnaire

We greatly appreciate you helping out and filling out these forms early.
Thank you and see you soon!

Contact Info

Address: 3316 Andrews Hwy, Midland, TX 79703

E-mail: info@regenpb.com

Phone : 432-688-1900