Patient Forms

If you are a patient of Dr. Shannon or the Surgery center, please choose the appropriate patient forms below.

Dr. Shannon's Patients

Please fill out the following forms, once they are completed, please email them to scheduling@keystonesurgery.com. We will have you sign them at your appointment. If you are not able to email them to us, you may bring them with you to your appointment.

Keystone Plastic Surgery - Medical Office Patient forms

Surgery Center Patients

Please fill the following forms out and sign in indicated areas. Once they are completed, please email them to scheduling@keystonesurgery.com or fax them to 888-321-4007. If you are not able to return them to us, you may bring them with you to your appointment.

Keystone SurgiCenter - Surgery Center forms

Get in Touch with Us

  • American Board of Surgery Certified Surgeon
  • Nearly 20 Years of Experience
  • On- Site Surgery Center
  • We Accept Most Commercial Insurance Plans for Reconstructive Surgery