(336) 765-8620 [email protected]
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Forsyth Plastic Surgery
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Forms

Please print and fill out these forms prior to your first visit to Forsyth Plastic Surgery. This will make your first visit efficient and save you time. Thank you!

• Intake Form

• Patient Information Form

• HIPAA Form

Contact us

336-765-8620

[email protected]

Winston-Salem:

2901 Maplewood Ave.

Kernersville:

231 Harmon Ln (Inside Central Carolina Dermatology Office).

Elkin:

150 Chatham Medical Dr.

336-835-1587

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Surgeons

  • Choosing a Surgeon
  • John A. Fagg, M.D., F.A.C.S.
  • Andrew M. Schneider, M.D., F.A.C.S.
  • Gilson J. Kingman, M.D., F.A.C.S.
  • George A. Lawson, III, M.D., F.A.C.S.
  • Leslie G. Branch, M.D.

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Forms

• Intake form
• Patient information form
• HIPAA form
  • Choosing a Surgeon
  • John A. Fagg, M.D., F.A.C.S.
  • Andrew M. Schneider, M.D., F.A.C.S.
  • Gilson J. Kingman, M.D., F.A.C.S.
  • George A. Lawson, III, M.D., F.A.C.S.
  • Leslie G. Branch, M.D.

LOCATIONS

Winston-Salem (Main Office):
2901 Maplewood Avenue
Winston-Salem, NC 27103
(336) 765-8620 (Phone)
(336) 768-6236 (Fax)

Kernersville:
231 Harmon Lane
(Inside Central Carolina Dermatology Office)
Kernersville, NC 27284
(336) 765-8620

Elkin:
150 Chatham Medical Drive
Elkin, NC 28621
(336) 835-1587

Our Board-Certified Plastic Surgeons

John A. Fagg, M.D., F.A.C.S.
Andrew M. Schneider, M.D., F.A.C.S.
Gilson J. Kingman, M.D., F.A.C.S.
George A. Lawson, III, M.D., F.A.C.S.
Leslie G. Branch, M.D.

NEW PATIENT FORMS

Intake Form

Patient Information Form

HIPAA Form

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