Cosmetic Surgery Evaluation Questionnaire

Form Template

This Cosmetic Surgery Evaluation Questionnaire Mobile App is intended for all new patients of plastic surgeons for the purposes of cosmetic procedures.

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This app has been designed to gather information from you, the patient, or someone whom you designate so that your board-certified plastic surgeon may develop a plan of care that most appropriately fits your needs. Use this app to best ensure that patients undergoing aesthetic surgery and/or procedures by a cosmetic surgeon have the best experience and health-related quality of life. As a patient, please be specific and provide surgical team with as much information as possible. Please note that photographs are a standard part of plastic surgery and will stay in your medical record.

A GoCanvas account can be specified as being HIPAA compliant. By turning on HIPAA compliance, a number of features that most of users find desirable will be disabled to meet HIPAA Standards. Individual apps in the GoCanvas Application Store can easily be made HIPAA Compliant. If you have any questions or need assistance, you can contact our Sales team to help you at If you would like to enable HIPAA on your GoCanvas account please follow the instructions below:

Log onto your Account. Click “My Account” in the top right corner of the screen. Click “Customize” on the left. The third option is for HIPAA Compliance, click “Edit” on the right. Check the “Enable HIPAA Compliance” box and select “Save.”"
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