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 Vein Patients - Please complete the following two brief forms:

Welcome to the LUMEN Laser Center Vein Questionnaire – Vein Patients

LUMEN Laser Center Patient History Vein Questionnaire – Vein Patients

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

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

LUMEN Laser Center Patient History Aesthetic Questionnaire – Aesthetic (Cosmetic) Patients

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

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