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-compliant 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 have to say that so far my experience with Dr. J is quit impressive. I do not particularly like going to doctors. As it seems often times the treatment ends up being worse than the original illness to begin with. So I was referred to Dr. J due to surgical incision from two years ago from having a spinal cord stimulator put in my back. Where the battery is placed in my left hip, the incision has never close. I do have to say that the waiting area is very inviting. I would have to say that the staff are very friendly, and they go above and beyond with helping answer any questions. My initial meeting with Dr. J was great, as he understood how nervous I was to be there. He listened to me, when I expressed certain concerns. He did reassure me that although I do have to have surgery, he explained to me exactly what he was going to do, without adding a bunch of scientific names that I would not understand. He assured me that he would take great care in helping with the infection and take the necessary steps to ease any discomfort that I might have. Dr. J seems so far to be extremely understanding, and that is a rare quality that not many doctors have.

    thumb Rlo Olr
    8/24/2019
  • 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. 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  I didn’t know what to expect at first.. but Dr. J answered all of our questions we had when we went in. He was so friendly and welcoming and so was the staff. Everyone there was amazing. I got all my questions answered so quickly with email. My surgery went great and I went in for my first Post op appt yesterday... I couldn’t be happier with the experience. Dr. J is absolutely amazing and I would recommend him to everyone given the chance.

    thumb Brandy W
    6/12/2019
  • review rating 5  Recently had surgery with Dr. J and I can not express my gratitude. The office staff is so kind and caring, paying very close attention to each patient, and incredibly considerate. Lovely and comfortable waiting area and very short wait times to be seen. I highly recommend Dr. J!

    thumb lobstah mobstah
    9/09/2019
  • 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
  • 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  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  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  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

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