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7777 Forest Lane, Suite C-230, Dallas TX 75230 • 972-566-2010

Patient Forms / Patient Portal

Our Patient Portal can be used to keep your information up to date, save you time, and provide additional resources for patient care and education.

Additionally, you can download, print, fill out and bring the following on-line forms with you on your next visit:


• MedSpa & Laser Consultation Form


• Financial Policy


• Health History


• HIPAA Consent


• Patient Information


• Photo Consent


• Patient Notice of Privacy

Keep and eye on your Body Mass Index (BMI)

According to the National Institutes of Health, the BMI is a way to measure your body fat. Based on your height and weight, the BMI calculator provides a reasonable assessment of your physical condition. Note that the Body Mass Index applies only to adult men and women. The weight ranges and category names are specified by the National Institutes of Health.

The key is to have “maintainable” weight at the time of surgery.

  • Normal: You may be an ideal candidate for specific procedures if your weight and height fall into the “Normal” category.
  • Underweight or Overweight: If you are either “Underweight” or “Overweight,” you need a consultation with one of our board certified plastic surgeons to determine whether you are a candidate or not.
  • Obese: If the computation categorizes your BMI as “Obese,” then we recommend that you bring your BMI into a lower category before having a consultation.

If your BMI is 35 or higher, anesthesia risks increase, as do the complications of surgery, including infections, seromas, and wound healing issues. You are also more likely to have co-morbid conditions that affect surgery, including heart disease, type 2 diabetes, high blood pressure, and breathing problems, all of which increase your surgical risk. Maintaining a healthy weight helps lower your risk of developing these problems, helps you feel good about yourself, and gives you more energy to enjoy life.

Please note:

Regardless of the procedure our patients undergo, all are required to download THIS FILE, which contains a list of the medications you MUST avoid 2 weeks prior to the procedure.

Patient Instructions

After visiting Clinique Dallas patients are provided with detailed instruction specifically designed for their treatment plans and needs. See attachments below for general PRE- and POST- procedural instructions.

Medspa & Laser Center Instructions

Halo Hybrid Fractional Laser

• After Care


diVa Vaginal Resurfacing

• After Care


Profractional MicroLaserPeel

• After Care


Laser Hair Removal

• Pre-Treatment


BBL / IPL Photo Therapy

• After Care


Chemical Peel Treatment

• After Care


Cosmetic & Reconstructive Instructions

Abdominoplasty

• Pre-Op | • Post-Op


Brachioplasty

• Pre-Op | • Post-Op


Breast Augmentation – Saline

• Pre-Op | • Post-Op


Breast Augmentation  – Silicone

• Pre-Op | • Post-Op


Breast Implant After Tissue Expander

• Pre-Op | • Post-Op


Breast Lift

• Pre-Op | • Post-Op


Breast Lift With Saline Implant

• Pre-Op | • Post-Op


Breast Lift With Silicone Implant

• Pre-Op | • Post-Op


 

DIEP Flap – [Reconstruction]

• Pre-Op | • Post-Op


Tissue Expander – [Reconstruction]

• Pre-Op | • Post-Op


Breast Reduction

• Pre-Op | • Post-Op


Eyelid Surgery

• Pre-Op | • Post-Op


Facelift

• Pre-Op | • Post-Op


Fat Injections

• Pre-Op | • Post-Op


Gynecomastia

• Pre-Op | • Post-Op


Implant Removal

• Pre-Op | • Post-Op


 

Implant Removal & Saline Implants

• Pre-Op | • Post-Op


Implant Removal & Silicone Implants

• Pre-Op | • Post-Op


Liposuction

• Pre-Op | • Post-Op


Necklift

• Pre-Op | • Post-Op


Nipple-Areola Reconstruction

• Pre-Op | • Post-Op


Otoplasty

• Pre-Op | • Post-Op


Rhinoplasty

• Pre-Op | • Post-Op


Scar Revision [Non-Surgical]

• Pre-Op | • Post-Op


 

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