Patient Forms
Thank you for scheduling your appointment with us!
If you are coming into one of our locations for your appointment, you can save some time by completing your patient registration paperwork now.
It’s easy and confidential!
Simply download the appropriate forms and fill them out on your computer or smartphone. If you have the updated version of Adobe Acrobat, you can click “share” and email the files directly back to us. If not, you will need to complete the form, select “print” and then “save as PDF.” You can then attach those files to an email to send back to us reception@burtplasticsurgery.com or fax to 815-267-8840. You may also print them out and bring them to you appointment.
**If you have an upcoming virtual consultation, please try to email the forms prior to your consultation.
We look forward to seeing you!
*Files require a PDF viewer such as Adobe Acrobat or Adobe Reader.