Forms

Please download, print and fill out these forms completely. Doing so will save you time when you arrive at our office for a consultation or seminar. We look forward to seeing you soon.

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Email Form(s) Here

Medical Weight Loss

New Patient Form Medical Weight Loss Questionnaire

V-Form Fat Reduction

New Patient Form V-Form Consent

V-ST Skin Tightening

New Patient Form V-ST Skin Tightening Consent

Fillers

New Patient Form Filler Consent

Neuromodulators

(Botox/Xeomin)

New Patient Form Neuromodulator Consent

Hormone Pellets

New Patient Form Hormone Consent Hormone Evaluation

Lap Band Adjustments

New Patient Form Band Fill Authorization/Surgical Weight Loss Follow-Up Post Band Adjustment Instructions

Laser-based Services

Hair Removal, Acne Clearance,

Skin Rejuvenation and Pigmentation Removal

New Patient Form Fitzpatrick Skin Definition Score IPL Laser Consent Form

Dr. Russell Gornichec and the entire Laser Solutions Medical Spa / Weight Loss Center of Arkansas staff is dedicated to delivering effective aesthetic solutions as well as eliminating the diseases associated with morbid obesity through conservative non-surgical means. Located in Hot Springs, near Little Rock, Arkansas, we are dedicated to effective care, patient safety, comfort and long-term support.