The Center for Plastic Surgery & Med Spa
Sandra Bouzaglou, MD, FACS
The Science of Medicine & Art of Beauty

Preoperative History & Physical Form

Please call and schedule an appointment with your primary care physician as soon as possible for evaluation and clearance for surgery.  Bring this form with you to give to your doctor so she/he is sure to provide all needed information.  If you are not evaluated and cleared for surgery your procedure will have to be rescheduled.  If you have any questions regarding this form please call our office at (859) 263-8083.

Pre-Operative History & Physical Form

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