Forms


 

If you are a new patient to our office, the attached files contain our new patient forms that will need to be filled out when you arrive at our office. Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them on your arrival. Thank you and please call our office if you have any questions at all.

Patient Demographic Form

Cosmetic Questionnaire

Notice of Privacy Practices

Current Medication List

Office Policies

Authorization Pictures Release Form

If you are a current patient and have misplaced your pre-operative or post-operative care instructions, please refer to the documents listed below. If you have any questions, please contact our office at (817) 336-9450.

Pre-Operative Instructions

Pre-Operative Care Instructions

Post-Treatment Instructions for Botox or Juvederm

Post-Treatment Care for Juvederm

Post-Treatment Instructions for DOT Skincare

Post-Operative Instructions / Lipo-Abdominoplasty or Abdominoplasty

Post-Operative Instructions / Breast Augmentation or Breast Lift

Post-Operative Instructions / Breast Reduction

Post-Operative Instructions / Brow Lift

Post-Operative Instructions / Blepharoplasty

Post-Operative Instructions / Liposuction

Post-Operative Instructions / Nipple and Areola Revision

Post-Operative Instructions / Otoplasty

Post-Operative Instructions / Rhinoplasty

This web site uses files in Adobe Acrobat Portable Document Format (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.

Location

Walter D. Gracia, MD, PA
1204 5th Avenue
Fort Worth, TX 76104
Phone: 817-336-9450

Office Hours

Get in touch

817-336-9450