Registration Form

Printable Registration Form

Filling out a new guest registration form can be tedious and annoying, especially if you are in a hurry or not feeling well. To minimize your valuable time in the office, Hybrid MD is providing our printable registration form for you to fill it out at your convenience. Simply bring the completed form with you and hand it to the front desk. Our Medical Front Desk Receptionist will be able to set you up almost immediately. For all new guests, an additional form, Arbitration Form will be required to filled out in the office. All forms must be filled out before seeing the physician.

Below are the registration forms: (click on the link and print)

New Urgent Care Visit

Returning Urgent Care Visit

Medical Marijuana New or Renewal

New Laser Treatment Registration

New Botox & Fillers Registration

New Age Management Form

New Workers’ Compensation Employer Registration Packet

Workers’ Compensation or Employer Paid Service Authorization Form ONLY

Pre and Post Care Treatment

Dr. Jairam firmly believes in preparing and educating our guests who are interested in Laser & Aesthetic Medicine. Besides offering a Complimentary Consultation, Dr. Jairam would also like to offer the Pre and Post Treatment Care for our current guests as well as our future guests. With this, Dr. Jairam will be able to inform the realistic expectation and the necessary steps to OPTIMIZE the end result.

Below are the Pre and Post Treatment Care: (click on the link and print)

Botox® & Dysport®

Juvederm® & Restylane®

Laser Hair Removal