Dr. Rankin Online Patient Forms

Click on the appropriate form below to fill out your information.

[All forms are encrypted and HIPAA compliant for your security]

Cosmetic Intake Form

Explant Questionnaire

Anesthesia Consent

Anesthesia History Form

Cancellation Policy

Elective Surgery Acknowledgement Form

Exparel Consent

Financial Responsibility Agreement

Medical Photograph Consent

Nicotine and Medication Warning

Revision Policy

Breast Implant Removal Consent

Breast Lift Consent

COVID-19 Informed Consent

Patient Travel Requirements