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Patient Forms

Conveniently located to serve the areas of New York, NY

We have provided a variety of forms for our patients to fill out prior to their visit. Downloading, printing, and filling these forms out before your visit will help reduce your time waiting. Please fill out these forms to the best of your ability. If you have any questions or concerns related to these forms, contact us at (212) 861-6400 or we can address them at your visit.

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Patient Information

Click here to open the Patient Information Form.

Web Release

Click here to open the Web Release Form.

Patient Health Questionaire

Click here to open the Patient Health Questionaire.

Cosmetic Questionaire

Click here to open the Cosmetic Questionaire.

Plastic and Reconstructive Surgery Photo Release

Click here to open the Plastic & Reconstructive Surgery Photo Release Form.

HIPAA Notice

Click here to open the HIPAA Notice.

About

Procedures

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Breast Augmentation
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Face Lift
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Liposuction
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Male Procedures

I Love Dr. Steven Wallach, hands up with praise and his receptionist Ashley and other staff is amazing. I love my new Wallach body if I could rate 100 stars I would.

Melisa G.

New York, NY

I got Lipo 360 and Lipo done to my inner thighs and it was honestly the best experience . Everyone in the office including him make sure I knew everything that was happening and honestly I love the results so much !!

Brittani P.

New York, NY

I’m so happy with the results from the Botox shots that Dr. Wallach performed on me. He spent a lot of time talking about the different fillers that would make my face look the most natural and youthful.

Beth

New York, NY

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