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Patient Forms

For your convenience, you can download these forms, fill them out in advance, and bring them to your appointment:

Medical History Form
Consult Questionnaire

Contact
Dr. Movassaghi

By providing my email address, I authorize and direct Movassaghi Plastic Surgery & Ziba Medical Spa to send me protected health information via UNSECURED email at the address provided. I understand the email is unsecure while in transit between the practice and me. The practice does not and cannot ensure the information will not be lost, compromised, or hacked while in transit, and I knowingly accept this risk. I understand that the practice will not condition provision of services or treatment on providing my email address.

330 South Garden Way, Suite 100 • Eugene, Oregon 97401
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Patient Forms

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