Karol Gutowski, MD, FACS

BOARD CERTIFIED PLASTIC SURGEON
773-985-3993

Instructions & Forms

Our staff looks forward to meeting you and discussing your cosmetic surgery goals. We strive to keep our appointments on time, as scheduled. Prior to your appointment, we encourage you to fill out the patient forms that are located on this website so that you can accelerate your check-in process. Please download, print and complete the forms and bring them with you to your appointment. If you are unable to download our patient forms, then it is recommended that you arrive to your appointment between 15-30 minutes early so that you can have ample time to fill out the appropriate forms. See below for all form categories. Click the category you are looking for to get started.

Body Contouring Procedures

Tummy Tuck (Abdominoplasty) & Body Lift:

Before Surgery Instructions: PreOp Instructions

Health Questionnaire: Body Contouring CHQ

Consent for Treatment: Body Contouring Consent

After Care Instructions: Abdominoplasty & Body Lift After Care

How to take medications for pain relief: Pain Medications

Medications NOT to take: Medications to Avoid Before Procedure

Incision & Scar Care Instructions: Incision & Scar Care

Abdominal Exercises (start 2 months after surgery): Effective Abdominal Exercises

Arm Lift & Thigh Lift:

Before Surgery Instructions: PreOp Instructions

Health Questionnaire: Body Contouring CHQ

Consent for TreatmentBody Contouring Consent

After Care Instructions: Arm Lift & Thigh Lift After Care

Medications NOT to take: Medications to Avoid Before Procedure

Incision & Scar Care Instructions: Incision & Scar Care

Liposuction:

Before Surgery Instructions (IV Sedation or General Anesthesia): PreOp Instructions

Before Surgery Instructions (Local Anesthesia): PreOp Instructions

Health Questionnaire: Body Contouring CHQ

Consent for Treatment: Liposuction Consent

After Care Instructions: Liposuction After Care

How to take medications for pain relief: Pain Medications

Medications NOT to take: Medications to Avoid Before Procedure

Incision & Scar Care Instructions: Incision & Scar Care

Breast Procedures

Breast Augmentation with Implants:

Before Surgery Instructions: PreOp Instructions

Health Questionnaire: Breast Augmentation CHQ

Frequently Asked Questions: FAQ Breast Augmentation

Consent for Treatment: Breast Augmentation Consent

After Care Instructions: Breast Augmentation After Care

How to take medications for pain relief: Pain Medications

Medications NOT to take: Medications to Avoid Before Procedure

Incision & Scar Care Instructions: Incision & Scar Care

FDA Material to Consider Before Breast Implant Procedures:

FDA Questions to Ask Before Breast Implant Surgery

FDA Things to Consider Before Getting Breast Implants

FDA Breast Implants Complications

FDA Silicone Gel Implants Safety Update 2011

FDA Update on Safety of Silicone Gel Implants Executive Summary

Breast Augmentation with Fat Transfer (Injection):

Before Surgery Instructions (IV Sedation or General Anesthesia): PreOp Instructions

Before Surgery Instructions (Local Anesthesia): PreOp Instructions

Health Questionnaire: Breast Augmentation CHQ

Consent for Treatment: Fat Transfer Consent

Dr. Gutowski’s Publication on Breast Fat Transfer: Breast Fat Grafting

Breast Implants vs Fat Transfer: Breast Fat Grafts Pros & Cons

How to take medications for pain relief: Pain Medications

Medications NOT to take: Medications to Avoid Before Procedure

Incision & Scar Care Instructions: Incision & Scar Care

Breast Reduction & Breast Lift (Mastopexy):

Before Surgery Instructions: PreOp Instructions

Health Questionnaire: Breast Reduction CHQ

Frequently Asked Questions: FAQ Breast Reduction

Consent for Treatment: Breast Reduction Consent

Consent for Treatment: Breast Lift (Mastopexy) Informed Consent

Consent for Treatment: Breast Lift (Mastopexy) with Implants Informed Consent

After Care Instructions: Breast Reduction After Care

How to take medications for pain relief: Pain Medications

Medications NOT to take: Medications to Avoid Before Procedure

Incision & Scar Care Instructions: Incision & Scar Care

Breast Implant Removal & Deflation:

Consent for Treatment: Implant Removal Consent

Consent for Treatment: SALINE Implant Deflation Consent

Facial Procedures

General: Blepharoplasty (Eyelid) & Browlift:

Before Surgery Instructions: PreOp Instructions

Health Questionnaire: Face CHQ

How to take medications for pain relief: Pain Medications

Medications NOT to take: Medications to Avoid Before Procedure

Incision & Scar Care Instructions: Incision & Scar Care

Blepharoplasty (Eyelid) & Browlift:

Consent for Treatment Blepharoplasty: Blepharoplasty Consent

Consent for Treatment Browlift: Browlift Consent

Consent for Treatment Blepharoplasty & Browlift: Blepharoplasty & Brow Consent

After Care Instructions Blepharoplasty: Blepharoplasty After Care

Face & Necklift:

Consent for Treatment Face & Necklift: Coming soon

After Care Instructions Face & Necklift: Coming soon

Nose Surgery (Rhinoplasty):

Consent for Treatment Rhinoplasty: Coming soon

After Care Instructions Rhinoplasty: Coming soon

Facial Implants:

Consent for Treatment Facial Implants: Facial Implants Consent

After Care Instructions Facial Implants: Facial Implants After Care

Ear & Otoplasty:

Consent for Treatment Ear Lobe Surgery : Ear Lobe Surgery Consent

Consent for Treatment Otoplasty (Ear Reshaping) : Otoplasty Consent

After Care Instructions Otoplasty: Otoplasty After Care

CO2 Laser Treatment:

Health Questionnaire: Face CHQ

Before Treatment Instructions: CO2 Laser Before

After Treatment Instructions: CO2 Laser After Care

Consent for Treatment: CO2 Laser Consent

Tretinoin Instructions: Tretinoin Instructions

How to take medications for pain relief: Pain Medications

Incision & Scar Care

Incision & Scar Care Instructions: Incision & Scar Care

Injectable Product Treatments

Botox, Dysport, Xeomin:

Health Questionnaire: Face CHQ

Basic Information: Botox Xeomin Dysport Overview

After Treatment Instructions: Botox Xeomin Dysport After Care

Consent for Treatment: Botox Xeomin Dysport Consent

Injection Work Sheet: Worksheet

Bellafill (Artefill), Belotero, Juvederm, Perlane, Radiesse, Restylane, Sculptra, Voluma:

Health Questionnaire: Face CHQ

Basic Information: Filler Overview

Before & After Treatment Instructions: Filler Before & After Care

Consent for Treatment: Filler Consent

Injection Work Sheet: Worksheet

Kybella:

Health Questionnaire: Face CHQ

Basic Information: Coming Soon

After Treatment Instructions: Kybella Before & After Care

Consent for Treatment: Kybella Consent

Injection Work Sheet: Worksheet

Labiaplasty Instructions:

Before Surgery Instructions (IV Sedation or General Anesthesia): PreOp Instructions

Before Surgery Instructions (Local Anesthesia): PreOp Instructions

Health Questionnaire: Body Contouring CHQ

Frequently Asked Questions: FAQ Genital Procedures

Consent for Treatment: Labiaplasty Consent

After Care Instructions: Genital Procedures After Care

How to take medications for pain relief: Pain Medications

Medications NOT to take: Medications to Avoid Before Procedure

Incision & Scar Care Instructions: Incision & Scar Care

Buttock Enhancement Instructions:

Before Surgery Instructions (IV Sedation or General Anesthesia): PreOp Instructions

Health Questionnaire: Body Contouring CHQ

Consent for Treatment Brazilian Butt Lift: BBL Consent

After Care Instructions Brazilian Butt Lift: BBL After Care

Consent for Treatment Buttock Implants: Buttock Implants Consent

After Care Instructions Buttock Implants: Buttock Implants After Care

How to Take Medications for Pain Relief: Pain Medications

Medications NOT to Take: Medications to Avoid Before Procedure

Incision & Scar Care Instructions: Incision & Scar Care

Procedure Instructions

Before your Surgery or Procedure:

Before Surgery Instructions (IV Sedation or General Anesthesia): PreOp Instructions

Before Surgery Instructions (Local Anesthesia): PreOp Instructions

Before Surgery Instructions(Office Procedure): PreOp Instructions

Medications NOT to take: Medications to Avoid Before Procedure

After your Surgery or Procedure:

How to take medications for pain relief: Pain Relief Medications

Skin Care Instructions:

Tretinion (Retin-A) Instructions: Tretinoin Instructions

Hydroquinone & Kojic Acid Instructions: Hydroquinone & Kojic Acid Instructions

General Information:

Privacy Notice: Privacy Notice