2030 Fleischmann Road
Tallahassee, FL 32308
Phone: (850) 219-2000
Monday thru Thursday: 8:30 a.m.–5 p.m.
Friday: 8 a.m.–1 p.m.
Monday thru Friday: 9 a.m.–5 p.m.
Monday thru Thursday: 6:30 a.m.–5 p.m.
Monday thru Thursday: 8:30 a.m.–4:30 p.m.
Friday: 8:30 a.m.–12:30 p.m.
Plastic Surgery Forms
At Southeastern Plastic Surgery, P.A. in Tallahassee, FL, we aim to make your entire experience as welcoming and convenient as possible. You’ll speed up your office visit by filling out these forms before you come into our office.
Southeastern Plastic Surgery, P.A. uses MyPatientVisit to provide a safe environment to fill out and submit your forms using encrypted servers and secure forms.
You will need a unique code, or to provide the office with your email address to create your profile. Please contact our office at (850) 219-2000 or contact our cosmetic coordinator to obtain your code before creating your profile. Click here to set up your profile.
Click on these forms below to open up a printable, Adobe Acrobat .pdf file. Thank you!
- Photography Release
- Advance Directives
- If you have an Advance Directive and/or Living Will, please provide a copy to the surgery center prior to your surgery. In the event of an emergency or other life-threatening situation, emergency medical procedures will be instituted and transfer will be made to a higher level of care. Should you require additional treatment at another facility, that facility will be notified of your wishes. Information on Advance Directives/Living Wills can be provided upon request. A sample copy is attached.
- Privacy Practice
- Patient Rights
- Non-discrimination and Accessibility notice (office)
- Non-discrimination and Accessibility notice (surgery center)
- Physician Ownership Disclosure Information
Please click here to login to our NexWeb Patient Portal to complete the following forms:
- Patient History Form
- Emergency Information and Next of Kin
- Patient Demographics