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Patient Forms

Thank you for choosing the North Shore Center for Facial Plastic & Cosmetic SurgerySM.

You may print these forms and complete them at your convenience. Please remember to take the completed forms to your scheduled appointment.

Registration Form

Patient Health Analysis

HIPAA Notice of Privacy Practices

Acknowledgment of Consultation Fee

Acknowledgment of HIPAA Privacy Practices

 
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North Shore Center for Facial Plastic & Cosmetic Surgery
North Shore: 330 West Frontage Road, Northfield, Illinois 60093
Downtown Chicago: Olympia Center, 737 North Michigan Avenue, Suite 1045, Chicago, Illinois 60061
South Chicago: University of Chicago Hospitals, 5841 South Maryland Avenue, Chicago, Illinois 60637
Northwest Chicago: St. Alexius Medical Center, 1555 Barrington Road, Suite 3350, Doctors Office Building Three, Hoffman Estates, Illinois 60169
 

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