Michigan Plastic Surgery

LEE H. COLONY, M.D., F.A.C.S.

EAST LANSING,MI
517-889-1297
Intake form

50% complete form 1 of 2

Personal Information
- -
Gender:*    
Contact Information
New / Existing Patient:    
Marital Status:                
Preferred Contact Method:                
Emergency Contact Information
Primary Insurance Information
- -
Terms & Conditions*
I have read and agree to this website's Terms of Use and Privacy Policy.
Digital Signature*

To confirm that you accept the information above, please enter your initials between two slashes into the box below. Example: John Doe would enter /JD/
Submit

Sign up to receive Exclusive
Specials and Event Info

Learn about cooladvantage
Fat reduction in as little as 35 minutes!
Schedule consultation

Michigan Plastic Surgery

2900 HANNAH BLVD., SUITE 110
East Lansing, MI 48823
United States

Phone: 517-889-1297 || Fax: 517-333-5970

5.0 stars - based on 16 reviews
COPYRIGHT 2017® | MICHIGAN PLASTIC SURGERY | Sitemap
Web Design & Marketing by
Translate »