Please fill out the forms below that you will need for your visits. You may also print out and fax these forms to our center at 610.525.5912, or bring them at the time of your visit.

For Our Varicose and Spider Vein Patients - Please complete the following brief form:

Welcome to the LUMEN Laser Center Vein Questionnaire and Vein History – Vein Patients

For Our Aesthetic / Cosmetic / Lipo Patients / Laser Hair Removal Patients - Please complete the following two brief forms:

Welcome to the LUMEN Laser Center Aesthetic Questionnaire – Aesthetic (Cosmetic) Patients and LIPO Patients

LUMEN Laser Center Patient History Aesthetic Questionnaire – Aesthetic (Cosmetic) Patients (Not needed for LIPO Patients)

For Our SmartLipo / VASER / VASER SHAPE / ZERONA Patients - Please complete the following form as well:

Medical History Form for SmartLipo / VASER / ZERONA / VASER Shape Patients - SmartLipo / VASER / ZERONA / VASER Shape Patients