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Patient Forms

Below you will find some patient forms and information to help you when you visit with our practice. If you have any questions about what to expect during your consultation or how to prepare for your procedure, please contact us online or by phone.

Abdominoplasty Consent Form
Abdominoplasty Liposuction Breast Augmentation Consent Form
Abdominoplasty Liposuction Breast Augmentation Mastopexy Consent Form
Abdominoplasty Liposuction Consent Form
Augmentation Mammaplasty Silicone Gel Consent Form
Augmentation Mammaplasty with Larger Implant than Recommended Consent Form
Blepharoplasty Consent Form
Body Lift Surgery Consent Form
Botox Consent Form
Brachioplasty Consent Form
Breast Augmentation Mastoplexy Consent Form
Breast Implant Removal Consent Form
Breast Lift Mastopexy Consent Form
Brow Lift Surgery Consent Form
Buttock Lift Surgery Consent Form
Filler Consent Form
Gynecomastia Surgery Consent Form
Liposuction Consent Form
Medial Thigh Lift Surgery Consent Form
Open Capsulectomy with Breast Implant Replacement Using Silicone Gel Filled Implants Consent Form
Otoplasty Consent Form
Reduction Mammaplasty Consent Form
Rhinoplasty Consent Form Torsoplasty

1505 Eastland Dr. Suite 350
Bloomington, IL 61701
Phone: (309) 663-1222
Toll Free: (888) 841-4108

Dr. Jeffrey Poulter specializes in procedures such as abdominoplasty, liposuction, body contouring after weight loss, BOTOX® Cosmetic injections, and breast augmentation for Illinois residents from areas including Bloomington, Normal, Decatur, Peoria, and Champaign, as well as patients from throughout the Midwest and beyond.

Patient Resources

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consultation request

Patient Forms