(713) 526 -5665

Houston Plastic Surgery patient forms

FORMS AND DOWNLOADS: the forms located below contain the initial information & history forms required to be completed by all patients before seeing Dr. Kridel.

By printing out and completing one of each of these initial encounter and history forms, you will save yourself the need to fill one out when you arrive at our office.

Please complete all the fields that pertain to you and enter "N/A" in those that do not. As our email is unencrypted, we would prefer that you not send personal information via email. Like all unencrypted Internet email communications, your email may be accessed and viewed by other parties, without your knowledge and permission, while in transit to us. By requesting information from us via e-mail, you are authorizing us to respond to you with an unencrypted e-mail message. For that reason, please do not email information to us that you consider to be confidential.  While we strive to protect your personal information, we cannot ensure the security of any information you transmit electronically to us, and you do so at your own risk. Feel free to return the completed form by fax (713) 526-5160 or bring it with you to your scheduled appointment.

Initial Information and History Forms

Initial Encounter Form

Patient History Form

New Patient Questionnaire

HIPAA Authorization Form