Dr. Mimi Lee must gather important information about your medical history and current physical condition so she can provide you with the best possible treatment. She also needs to keep emergency contacts and insurance information up-to-date.
For your convenience, our New Patient Forms are available below for completion online. We request these forms to be completed at least 48 hours prior to your appointment. If you choose not to complete the forms online before your appointment, you can request forms to be mailed to you so you may bring them with you; or you can arrive 30 minutes early to complete the forms to avoid delay of your appointment.
To complete our New Patient Forms online, please first read and/or print the instructions below, and then click on the New Patient Form link at end of this page to begin:
- This is VERY IMPORTANT: Please write down your login & password so you can refer back to it in case you are disconnected.
- You will need to have insurance information and medication list ready as the system has a time out because of government regulation for privacy protection.
- To complete the form, an email address is required. If you have no email address, please enter your first two initials and the initial of your last name @nomail.com ( ex. – patients name John Smith, jos@nomail.com). Add a number if that email has already been added (ex – jos9@nomail.com)
- Vein patients please complete the Medical History (Non-General) Form.
You must complete ALL SECTIONS of this form. If any fields are left blank, the form may not save properly. Put “none” or “N/A” (not applicable) when needed. - Aesthetic (Botox/ Dermal Filler) patients please complete the Medical History (General) Form.You must complete ALL SECTIONS of this form. If any fields are left blank, the form may not save properly. Put “none” or “N/A” (not applicable) when needed.
Forms
- New Patient Forms
- View Notice of Privacy Practice
- View Acknowledgement of Notice of Privacy Practice (You will be asked to sign at our office)
- View Appointment and Financial Policy (You will be asked to also sign this at our office)
The above forms may require Adobe Acrobat Reader™. You may download Adobe by following this link: