accessibility ACCESSIBILITY
BARRINGTON PLASTIC SURGERY, Ltd
Est. 1979
C. PELLETIERE, MD V. PELLETIERE, MD

Patient Forms

Below are three introductory forms that are necessary to create your patient chart.  These can be downloaded, printed out at home, and filled out ahead of your appointment.  This saves you time when coming in and allows us to speed up the check in process.

 

Patient Intake Form

Health Form page 1

Health Form page 2

Contact Us

We encourage you to contact us with any questions or comments you may have. Please call our office or use the contact form below. Note: by sending an email with any specific patient information, you agree to be entering into a doctor-patient relationship with our office. Sending confidential information electronically has inherent risks, even with the best encryption. We do our best to maintain the strictest HIPPA privacy compliance at all times.
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Office Location

  • Inverness
  • 1602 Colonial Parkway
  • Inverness, IL
  • 60067
  • Map & Directions
  • Call: 847-358-9444

Testimonials

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