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  I would recommend dr. William Jacobsen to anyone who is interested in doing any kind of procedure. I got a chest augmentation and he did an amazing job! I am very happy and he did exactly the shape and size I was wanted. Go to his website and you will not be disappointed !

    thumb Mirela Eastridge
    2/20/2019
  • 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
  • review rating 5  I've had four visits with Dr. Jacobsen over the past 2.5 years, the first after the removal of 1/3 of my bottom lip from skin cancer, and the last for a biopsy of possible skin cancer on my nose. Each time, he has treated me with kindness and respect, and also had a level of confidence that made me feel relaxed with whatever he thought best for the particular problem. Thus far, the results have proven him correct. He has quickly become my go-to for any problem or condition that may create a cosmetic "issue". His office and staff make you feel welcomed and comfortable, and he promptly and generously responds to questions or concerns by email. One visit and you'll find these things out yourself.

    thumb Jay Phillips
    4/18/2018
  • review rating 5  Dr. J is an amazing surgeon . he also has an exceptional staff. I am very thankful for this whole staff.

    thumb Dawn Simpson
    4/01/2019
  • review rating 5  Hi Dr. J ., Tracy, Ashley, Kimberly and Susan- I came back to your surgical practice as I was very pleased with previous results. I find again a very caring atmosphere and staff and I am excitedly anticipating future results of your excellent technical expertise. Waiting to hear from you regarding the rest of the repair work yet to be done. Happy New Year and Happy Blessings to all of you! Thanks so much, Lisa Bishop

    thumb Lisa Bishop
    1/06/2018
  • review rating 5  Dr. Jacobsen and his team are beyond exeptional! From the moment you walk in you are treated with care and professionalism. Very very impressed! Thank you Absolutely recommend!!!

    thumb ester zav
    7/25/2018
  • 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  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 J is a kind, compassionate, extremely gifted surgeon. I’ve now had two procedures preformed by him and both he explained and executed beautifully. He is always there to answer questions before and after surgery. You will most likely wait about a hour longer then your expected appointment time but he is definitely worth the wait.

    thumb Jennifer Arena
    5/14/2019
  • review rating 5  Dr J is the best! I have an ongoing issue with a medical implant that he has cleared up several times. Every time I contact him he is right there. This last time he actually met me on a Sunday to help me. I highly recommend Dr J. His bedside manner makes you feel that no matter what everything will be okay.

    thumb Donna Brockway
    7/14/2019

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