Patient Registration Form

Welcome to the Patient Forms section of our website! In order to expedite the administrative process of your first visit, you may choose to fill out the required paperwork online.

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If you would feel more comfortable filling in this paperwork in-office, please feel free to do so by arriving 20 minutes before your first appointment at our office. Once completed please send to Dr Jacobsen’s staff by email info@drjsoffice.com or fax at 602.279.1701.

Our ultimate goal is to heal.

Dr. J and his staff look forward to understanding the details of your unique case, desires and aspirations, and to providing you with realistic, safe and attainable results that leave you looking beautiful, and truly feeling like yourself. Take the first step toward your healing or rejuvenating procedure with Dr. J by filling out our contact form to request a consultation, or to inquire about any of the services we offer. We look forward to treating you!

I came to Dr. Jacobsen after extensive research on plastic surgeons. I had lost 80lbs and have had 3 children so I had the tummy apron and wanted a panniculectomy. The process from start to finish was seamless. His office staff is kind and courteous. I was able to get for my consult quickly and surgery was scheduled fast as well. On my surgery day, Dr. Jacobsen was excited to get my surgery completed and happy for me. He had the biggest smile on surgery day. The procedure was quick and went so well. I was able to come home and recover but he is always available by text. He has answered my questions on the weekend. I had my two-week post op check and he told me how well I was doing on my incision care. I cannot recommend a better Plastic Surgeon than Dr. Jacobsen.

Summer Bert

I had a great experience during my consultation with Dr. J and his staff. They made me feel super comfortable as soon as I walked in even though I was a nervous wreck. Everyone was so sweet, nice and very knowledgeable. What I wanted done Dr. J surprised me with his answer. Which is why I will be scheduling an appointment for a breast augmentation soon with him. Also, I hate talking on the phone so I am able to contact them by text or email with any questions or concerns I have, and with my busy schedule it works out for both parties. I will have to edit this review with the results of my procedure and recovery process. As for a consultation experience, I have no complaints.

Amanda Lewis

I came to Dr. Jacobsen after extensive research on plastic surgeons. I had lost 80lbs and have had 3 children so I had the tummy apron and wanted a panniculectomy. The process from start to finish was seamless. His office staff is kind and courteous. I was able to get for my consult quickly and surgery was scheduled fast as well. On my surgery day, Dr. Jacobsen was excited to get my surgery completed and happy for me. He had the biggest smile on surgery day. The procedure was quick and went so well. I was able to come home and recover but he is always available by text. He has answered my questions on the weekend. I had my two-week post op check and he told me how well I was doing on my incision care. I cannot recommend a better Plastic Surgeon than Dr. Jacobsen.

Summer Bert

I had a great experience during my consultation with Dr. J and his staff. They made me feel super comfortable as soon as I walked in even though I was a nervous wreck. Everyone was so sweet, nice and very knowledgeable. What I wanted done Dr. J surprised me with his answer. Which is why I will be scheduling an appointment for a breast augmentation soon with him. Also, I hate talking on the phone so I am able to contact them by text or email with any questions or concerns I have, and with my busy schedule it works out for both parties. I will have to edit this review with the results of my procedure and recovery process. As for a consultation experience, I have no complaints.

Amanda Lewis

I came to Dr. Jacobsen after extensive research on plastic surgeons. I had lost 80lbs and have had 3 children so I had the tummy apron and wanted a panniculectomy. The process from start to finish was seamless. His office staff is kind and courteous. I was able to get for my consult quickly and surgery was scheduled fast as well. On my surgery day, Dr. Jacobsen was excited to get my surgery completed and happy for me. He had the biggest smile on surgery day. The procedure was quick and went so well. I was able to come home and recover but he is always available by text. He has answered my questions on the weekend. I had my two-week post op check and he told me how well I was doing on my incision care. I cannot recommend a better Plastic Surgeon than Dr. Jacobsen.

Summer Bert

Text: (623) 888-8152
Voicemail: (602) 212-0100
2525 East Arizona
Biltmore Circle, Suite C236
Phoenix, AZ 85016