Patient Forms

Patient Information

We appreciate you trusting us for your gynecologic and aesthetic needs. As a highly trained, board certified physician, Daisy A Ayim MD FAACS | Cosmetic Surgeon provides honest, quality care and meticulous attention to details.

Returning Patient

If you are a returning patient and need to schedule a new appointment or check your lab, please click the image below.

New Patient

We provide all of our new patient forms online so you can complete them in the convenience of your own home.

• Schedule an appointment
• Patient Demographic Form
• Dr Ayim consent Form
• Medical Release form
• Patient Financial Responsibility Acknowledgement
• Privacy Form
• Patient’s Rights Responsibility Form
• HIPAA Notice of Privacy Practices
• HIPAA Patient Handout
  1. If you do not already have AdobeReader® installed on your computer, click the image to download it for free.
  2. Click on the demographic form, print it out and fill in the required information.
  3. Please bring your printed and completed forms with you to your appointment and save time on your visit!