Patient Forms

Welcome to Burgess Plastic Surgery and In My Own Skin Med Spa! Want a head start on your new patient paperwork? Please print and fill out the required forms below, and then bring to your scheduled appointment.

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Burgess Plastic Surgery will be following Oregon safety measures to help prevent the spread of COVID-19 virus.

We ask that our patients:

  • Bring a facial mask or cover and wear during your time in the office. We understand that the mask mandate has been lifted in Oregon, however this does not apply to medical offices.
  • You are welcome to bring one guest with you to your appointment.

If you are feeling unwell, have known exposure to COVID19, a persistent cough, or have a fever, we will reschedule your appointment.

We thank you for your cooperation during this time.

Schedule A Consultation

FILL OUT THE FORM OR CALL US

WHAT HAPPENS IN A CONSULTATION?

01. Get to know your provider.
02. Help her understand you and your goals.
03. Learn about our services and specialties.

“Dr. Burgess and her staff are amazing. From the moment I walked into the office I was treated with respect and kindness. Everyone I encountered is professional and makes you feel safe and special. And the best part.... I love my results! I can't thank you enough.”

–Dawn Funk, Actual Patient

HOW MAY WE HELP?

* All indicated fields must be completed.

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CONTACT US

OFFICE HOURS

Mon-Thurs: 8am-5pm
Friday: 8am-4pm
Saturday: By Appointment

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