Patient Forms

Welcome New Patients!


Get a head start on your paperwork. Please print and fill out each of the forms below and bring them with you to your appointment.

Burgess Plastic Surgery will be following Oregon safety measures to help prevent the spread of COVID-19 virus.

We ask that our patients:

  • If you have an appointment with us, please call our office 503-905-9363 to let us know you are here.
  • Bring a facial mask or cover and wear during your time in the office
  • Please do not bring your kids, family or friends into clinic with you. If you are under 18 years of age or are going through breast cancer treatment, one additional person may accompany you.
    *Patients can call or facetime friends and family while in clinic

If you are feeling unwell, have known exposure to COVID19, a persistent cough, or have a fever, we will reschedule your appointment.

We will be taking your temperature upon arrival.

We thank you for your cooperation during this time.

We look forward to meeting you!

Please download and complete the entire patient packet and bring it to your consultation to make the check in process go smoothly.


COVID requirements


8:00am - 5:00pm


8:00am - 4:00pm

Saturday hours available by appointment

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