Patient Forms in Bellevue

Vasectomy Forms

– Vasectomy Informed Consent Form

– Formulario de Consentimiento para Vasectomía sin Bisturí (español)

– Pre Vasectomy Instructions

– Instrucciones De Cuidado Previo A La Vasectomía (español)

– Post Vasectomy Instructions

– Instrucciones De Cuidado Posterior A La Vasectomía (español)

– Vasectomy Financial Policy

 – Politica financiera vasectomia (espanol)

Circumcision Forms

– Pre-Circumcision Instructions

– Instrucciones previas a la circuncisión (español)

– Post-Circumcision Instructions

– Instrucciones para después de la circuncisión (español)

– Circumcision Consent Form

– Formulario de consentimiento para la circuncisión (español)

Financial Policy Forms

 – Pacific Clinic Financial Policy

– Politica Financiera Pacific Clinic (espanol)

Men’s Sexual Health Forms

 – UpSize Consent Form

– Penile Enlargement Post Procedure Instructions

– UpSize Firm-X Consent Form

– Penile PRP Injection Consent Form

– Penile PRP Injection Post Care Instructions

Women’s Sexual Health Forms

– MONALISA TOUCH Consent Form

– MONALISA TOUCH Post-Procedure Instructions

Hormone Replacement Therapy Forms

– Post-Procedure Instructions Care

Potenza RF Microneedling Forms

– Epicutis Care Instructions

– Potenza Consent Form

– Potenza Post-Treatment Instructions

– Potenza Pre-Treatment Instructions

SmartXide CO2 Laser Forms

– Epicutis Care Instructions

– SmartXide Touch Post-Skin-Treatment Instructions

– SmartXide Touch Pre-Skin-Treatment Instructions

– SmartXide Touch Skin-Treatment Informed Consent Form

FoLix Laser  Forms

– Patient Consent Form

– Pre-Procedure Instructions

– Post-Procedure Instructions

Joint Pain & Tendonitis Forms

Coming soon..

miraDry Forms

– Consent Form

– Post Procedure Instructions

– Post Procedure Instructions Spanish

– Pre Procedure Instructions

– Pre Procedure Instructions Spanish

Longevity & Wellness Medicine

Coming soon..

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*All indicated fields must be completed.
Please include non-medical questions and correspondence only.

offce hours

Monday - Friday : 8am - 5pm
Saturday : By Request Only
Sunday : Closed

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