Plastic Surgery Patient Forms

Choosing to have plastic surgery, or any cosmetic procedure, is a very personal decision, choosing the right plastic surgeon is a very smart decision. Thank you for choosing Dr. Rod and Dermacare Cosmetic Surgery.

A successful procedure has the ability to give you greater confidence in the years to come as well as make you feel better about yourself. Knowing you have chosen the right surgeon will save you the heartache of poor results, which could lead to additional time and money to correct.

You can accelerate your check in process with Dermacare by downloading, printing, and completing the necessary forms below before you have your first visit with us.


These forms must be printed and completed by hand and cannot be transmitted electronically. Should you wish to send these forms in advance of your first visit, we highly recommend that you use a shipping method with tracking, such as DHL, FedEx, or UPS. Please send to our Goodyear office at 14551 W. Indian School Rd., Suite 240, Goodyear, AZ 85395. To view these forms, you must have Adobe Acrobat Reader.


AZ Dermacare New Patient Registration Form


AZ Dermacare Botox® Informed Consent Form

AZ Dermacare Dermal Filler Informed Consent Form

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