PATIENT

PATIENT REGISTRATION FORM

Please download the Patient Registration Form below, and fill out the form.  Submit the filled registration form,a copy of your Identification Card (Driver's License or Passport) and Photographs via email at info@delacruzplasticsurgery.com.​

  1.  Patient Registration Form

  2. Photograph Submission Instruction for Patients

  3.  HIPAA Privacy Policy

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The Woodlands Clinic

2219 Sawdust Road Unit 1203  The Woodlands, TX

77380

Houston Clinic  (Coming Soon)

15018 FM 529

Houston, TX 77084

© 2018 De La Cruz Plastic Surgery and KOKO Art Studio. All Rights Reserved.