1122 Street Rd Suite 100 | Southampton, PA

Patient Forms

We are always excited to meet new patients during their first visit to our office. We will make every effort to ensure that your first visit with us is a comfortable and educational experience.

For your convenience prior to your first appointment, you may download our New Patient Forms. Print the form by clicking on the link below. Once completed, it can be faxed, mailed, or brought with you on the day of your consultation.

Please click the below links to download patient forms:

Click Here to download the patient forms.

PicoSureTM Laser Tattoo Removal Pre and Post Care Instructions

Click Here to download the PicoSure Instructions.

You’ll need Adobe Reader to open the files; click here to download it if you do not have it installed on your computer.

Note: Please print the pages, fill them out, and bring them to the office.

What you should bring…

  • Your insurance card along with another form of I.D. (i.e. – Driver’s License, State ID card, Military ID)
  • X-Rays, MRIs, CT scans, Biopsy reports or other pertinent medical records
  • Information about prescription medications which you may be taking
  • A referral from your Primary Doctor (if necessary)
  • Cash, Checks, Credit Cards (Visa, MasterCard, American Express, Discover) for your co-payment if applicable

Our Facility

The Kole Plastic Surgery Center is a licensed private plastic surgical center in Southampton, Pennsylvania. The Pennsylvania Department of Health has granted this Center a license since opening in March 2005. The Kole Plastic Surgery Center is a completely private center. Dr. Kole is the only surgeon who performs surgery at the center. We limit our practice exclusively to cosmetic plastic surgery procedures.

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