Registration Forms

Lafayette Parish – Baton Rouge and Lake Charles, Louisiana Dermatology and Medical Spa

Click on images below to view and/or download the Forms.  To make your visit to our office faster, you may fill out the forms prior to your arrival.  If you have any questions, call us at (337) 989-7272.


pdf Cosmetic Interest Questionnaire

pdf Patient Registration Form

pdf Medical History
Form

 

 Cosmetic Interest Questionnaire

 

 Patient Registration Form

 

 Medical History
pdf HIPAA Release
Form

pdf Disclosure Statement

pdf Photo Release
Form

 

 HIPAA Release

 

 Disclosure Statement

Photo Release Form
    pdf Financial Policy
Form

    

 

  

 

 Disclosure Statement

 

  

 
a Jeuné Medical Spa is located within the office of Acadiana Dermatology. Visit our Medical Spa and Dermatology office located in Lafayette, Louisiana (LA).
Your Skin. Our Experts. Beautiful You! Christopher Hubbell, M.D.
Founder & Medical Director, a Jeuné and Acadiana Dermatology
Board Certified Dermatologist / Dermasurgeon Please ask about our complimentary VISIA Digital Complexion Analysis.