Patient Forms

Patient Forms

By printing and completing the forms below, people visiting us for plastic surgery from Walnut Creek, CA and other nearby communities can help us welcome them to the practice and save time during their first visit. If you have questions about the information we are requesting, we’re happy to help. You can contact us online or call (925) 685-4533.

New Patient Registration Forms

To download, fill out and print forms for your visit, please click the following form icon:


Consultation Consent Form

You can download and review a copy of this form before your initial visit:

Patient Forms

Notice of Privacy Practices

You can download and review a copy of our Notice of Privacy Practices before your initial visit:

HIPAA Notice Form

Covid-19 Informed Consent

Please download and complete this form prior to your office visit so you are aware of our policies and procedures:

Covid Form 2

MSpa Intake Form

To download, fill out and print your intake form for your visit to MSpa, please click the following form icon:

MSpa Inktake Form

Injectable Treatment Consent Form

If you will have facial augmentation with injectable dermal fillers and/orbotulinum toxin type A (BOTOX, Dysport, Xeomin) please download and review this form before your visit to MSpa:

Patient Forms

or call our Concord office at 925-685-4533 to request a consultation.

Request a Consultation Today!

Patient Forms
Article Name
Patient Forms
Get the patient information form for board-certified plastic surgeon Dr. Eric Mariotti in Concord, CA.
Publisher Name
Dr. Eric Mariotti
Publisher Logo