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Patient Forms



Patient Forms


All new patients must view our Privacy Notice before completing the HIPAA Disclosure Consent and Financial Policy Form.

  • For medical appointments, complete the Medical History Form.
  • For esthetic appointments, complete the Esthetic History Form.

Schedule your appointment today!



Contact Us

  • Phone
    765.288.6200
  • Fax
    765.288.4131
  • Address
    401 W McGalliard Rd
    Muncie, IN 47303
  • Email
    info@lifetimeskincarecenters.com

Please be advised that we will not respond to medical questions or photos via this email.

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