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Plastic Surgeons of Akron
Call 330-344-3223 | Contact Us

Patient Forms

Save time at your visit!

The links below allow you to access the patient forms needed to get started at your appointment. These forms can be filled out using your computer or tablet. Simply fill out the forms and print them out, then bring them along with your current insurance information.

Our staff and Dr. Pedersen look forward to meeting you!

 Patient Registration Form

Health Questionnaire

HIPPA Policy

Patient Photo Release


* Disclaimer: Photo representation of procedures and services are models and should not be deemed as expected results.