New Patient Information

Hours of Operation

We are open from 8:00am to 5:00pm daily, Monday through Friday.

Intake Forms

Before your first appointment, please download and print the following simple intake forms and bring the completed forms with you. We will also need a copy of your photo ID, and copies of medical insurance cards, if applicable, so please bring these with you. If any of your information changes after your initial form is on file, please fill out a new form and update any relevant information. In order to make life a bit simpler, we have forms that you can actually fill out on line.

Instructions for patient forms: Click the links below to download and print your forms. You can send completed forms to us via postal mail or bring them with you to your appointment. To protect the privacy of your personal information, we do NOT accept patient forms via email.

Patient Forms:

INSTRUCTIONS: please click the links below to download the form, print it on your printer and bring in to your appointment.

Cosmetic Procedures - Self Pay
If you are strictly a self-pay patient, please download and fill out these forms:

Cosmetic Procedures - Insurance and Self Pay
If you are using a combination of insurance and self-payment, please download and fill out these forms:

Insurance Forms
If your insurance carrier will be covering the cost of treatment, please download and fill out these forms:

Spa Treatments
If you are only having spa treatments, please download and fill out these forms:

Post-Operative Care Instructions

Medical Records

If you need copies of your medical records, please fill out this request form and mail or fax to us. We will let you know if a fee applies before we send any records.


  • Medical Records Form (coming soon)
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Copyright 2016 Dr. John Burroughs, M.D. P.C. All rights reserved.
300 Garden of The Gods Road, Suite 100, Colorado Springs, CO 80907 | 719-473-8801