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PATIENT

PATIENT REGISTRATION FORM

Please download the Patient Registration Form below, and fill out the form.  Submit the filled registration form, a copy of your Identification Card (Driver's License or Passport) and Photos via email at info@delacruzplasticsurgery.com.​

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  1.  Patient Registration Form

  2. Photograph Instructions for Patients

  3.  HIPAA Privacy Policy

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© 2018 De La Cruz Plastic Surgery and KOKO Art Studio. All Rights Reserved.
 

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