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. The below form is a secure, HIPAA-complaint form that will be received by our office administrator.


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. You may also choose to fill out this form offline by downloading it in PDF form by clicking here. Once completed please send to Dr Jacobsen’s staff by email info@drjsoffice.com or fax at 602.279.1701.

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!


4.9 Average Rating  |  Click to view over 370 reviews



4.8 Average Rating  |  Click to view over 170 reviews



4.7 Average Rating  |  Click to view over 120 reviews
  • review rating 5  Dr. William Jacobsen and his entire staff are all very educated, professional and extremely responsive to any questions or concerns. They set up very real expectations for me after taking the time to help me understand what was hoped to be achieved. I have been treated with the highest respect and kindness. Dr. Jacobsen has an extraordinary bedside manner and met my needs and expectations in every way! With future facial and cranial reconstructive surgery to be performed, I am confident in facing the future with the care and golden hands of Dr. William Jacobsen.

    thumb SANDIYA McClendon
    2/03/2018
  • review rating 5  I think he’s a wonderful surgeon and extreme talent. I can in for a bilateral breast augmentation after having breast fed my 2 sons. What he did to my body and self esteem is immaculate. I’m so happy with his hand I work. I had almost NO bruising at all and they gave the the perfect amount of pain medicine to get me though and still functioning. I gave him a 5 star rating because of his skills and professionalism. How ever if you don’t come stacked with your own questions and concerns he can’t do anything for you. He’s a surgeon who knows all this stuff but not exactly the fountain of information. He will litterly only tell you and give you what you ask for. Don’t make him guess or try to let him lead the conversation when it comes to concerns and post up care. Make a list of questions and stick with it. He will answer them all perfectly. It’d help to do your research and bring your own pictures with a ‘cc’ in mind. HE WILL GIVE YOU WHATEVER YOU ASK FOR!❤️

    thumb Laura Hoskins
    3/24/2019
  • review rating 5  Great experience with Dr Jacobsen. I had a tummy tuck, breast lift with implant exchange and I am very happy with the results. Dr. J came to the hospital the night after I had the surgery to check on me. Very impressed. Dr J did a wonderful job and I will highly recommend him. "High Class" Doctor and office as well. Thank you. (01/10/19)

    thumb Ellie Proteasa
    1/11/2019
  • review rating 5  Dr. Jacobsen is a highly skilled and compassionate surgeon. He removed a malignant melanoma from the left side of my face. He was thorough and precise. I am now cancer free. The result is outstanding. Dr. Jacobsen and his staff are outstanding when it come to communication! I left a voice mail at his office on a Saturday morning and Dr. Jacobsen called me back himself within 15 minutes! He requested me to immediately email photos and the lab report. I did so and again heard back from him within 15 minutes! His web site has links to contact the office directly. This type contact is promptly answered. I highly recommend Dr. Jacobsen.

    thumb Mark McKinney
    10/17/2018
  • review rating 5  Dr. Jacobsen and his entire office staff was a great experience for me. I was referred to his office after my MOHS procedure that left my face in worse shape than I had hoped for. It was a drive across town for me and it was well worth it. I was concerned about the state of the open wound on my face and desired the best outcome possible, I was worried. From the moment I stepped into his office I felt at ease. Several things impressed me with Dr. Jacobsen and his office staff. First and foremost was the ease of communication both directly in office and submitting documents and photos via his website and/or email. The ability to reach out to and get a response from the doctor 24/7 is so nice. Each person I spoke to was helpful and was mindful and sensitive to my needs. Dr. Jacobsen was great, he was very personable, very easy to talk to you, he answered all my questions, and was confident in his skill. I truly felt it was a blessing to be referred to and treated by Dr. Jacobsen. Lastly, Dr. Jacobsen's office is beautifully designed and decorated and includes WIFI, these little things all help with setting the right environment. I left Dr. Jacobsen office in far better shape than when I arrived. His many years of experience is evident in his work.

    thumb Aaron Richins
    7/30/2018
  • review rating 5  I couldn't be happier with my procedure. Dr. J has the most kind and relaxing manner and he is the ultimate professional. I had a fatty tumor on my forehead that he removed, as well as breast reconstruction. The breast reconstruction was overdue as I had breast cancer with multiple lumpectomies, biopsies and radiation. It left the tissue hard and my old implant like a rock. He was able to correct all of the problems and I'm much happier with my appearance. Although you may find it odd at first that you can't get anyone by phone their response time is amazing. I emailed the office on a Sunday afternoon that I had a problem and within ten minutes (no exaggeration) I had a text back that a prescription had been called in to my pharmacy. I've had procedures with other doctors around the Valley and never had an experience more pleasant, nor one which I was happier with the results.

    thumb Leslie Keller
    10/16/2017
  • review rating 5  He is the best doctor I am so so happy with my tummy tuck thank you DR William m .Jacobson

    thumb Nehmah Salem
    2/12/2019
  • review rating 5  My dad is the best Dad. Do not try to tell me otherwise please and thank you.

    thumb Oliver Jacobsen
    2/18/2019
  • review rating 5  I'm having a hard time with this because, I can't say enough good things about this office! Dr. Jacobsen is an amazing surgeon. He is always available, for any questions or concern. His staff go way beyond any other office I have seen. They are more than helpful with insurance, appointments, or any issue or questions. The office is both beautiful, and comfy. Like I said can't say enough.

    thumb J Basom
    1/25/2018
  • review rating 5  So pleased with my whole experience! I thank everyone for making me feel good about myself again and being fantastic through my whole experience!

    thumb Sandy Cosper
    3/12/2019

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