contact us
REGISTER
The Advanced Cosmetic
Laser Center Benefits Program delivers personalized and intriguing offers as well as access to exclusive events
LEARN MORE
   
CHECK IN FORMS
CURRENT ADVERTISEMENTS
GIFT CERTIFICATES
NETWORK LINK EXCHANGE
OFFICE HOURS
PATIENT FINANCING
PATIENT TESTIMONIALS
PRIVACY PRACTICES
REFER A FRIEND
THE STEVE KANE SHOW 1470 AM
EMPLOYMENT OPPORTUNITIES
TABLE OF CONTENTS
NEWSLETTER
Request an APPOINTMENT

CHECK IN FORMS

Below, please find the Patient Information Data Form and the HIPPA forms to be filled out prior to the time of check in.

In order to expedite your check-in process, please print both of the documents below and fill them out prior to your appointment and give to our receptionist at the time of check-in.

 Upon completion of printing these forms, please hit the back button to return to our website.

PATIENT CHECK-IN FORMS - ENGLISH VERSION.pdf

PATIENT CHECK-IN FORMS - SPANISH VERSION.pdf 

HIPAA - ALL FORMS COMBINED 

 

 




FINANCING AVAILABLE

Se Habla Español

Copyright, 2007 Janee D. Steinberg, M.D. P.A. d/b/a Advanced Cosmetic Laser Center,
All World Wide Rights Reserved