New*Patient*Welcome*Packet* 817>477>9000

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Dear*Patient,*
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Welcome*to*Mansfield*Cosmetic*Surgery*Center,*the*cosmetic*surgery*practice*of*Dr.*
Michael*L.*Thornton,*a*fellowship>trained*cosmetic*surgeon*and*Diplomate*of*the*American*
Board*of*Cosmetic*Surgery.*
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This*New$Patient$Welcome$Packet*will*specifically*provide*valuable*information*about*the*
various*cosmetic*surgery*services*offered*at*Mansfield*Cosmetic*Surgery*Center.**It*will*also*
contain*information*about*our*cosmetic*surgical*practice,*profile*of*Dr.*Michael*Thornton,*
our*office*hours*and*location,*the*appointment*and*consultation*process,*as*well*as*provide*
information*about*your*financial*options*to*obtain*affordable*cosmetic*surgery.***
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To*expedite*your*overall*consultation*process,*please*take*time*to*complete*the*attached*
Medical$History*form*before*your*visit*with*Dr.*Michael*Thornton*and*bring*to*your*
consultation.**If*you*desire,*you*may*either*email*or*fax*the*completed*form*prior*to*your*
office*visit.**as*it*will*expedite*your*overall*consultation*process*
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Feel*free*to*contact*our*office*to*discuss*any*concerns*you*may*have*about*your*cosmetic*
surgery*consultation.**It*is*very*important*that*your*questions*are*answered*before*you*
undergo*any*surgical*or*non>surgical*procedure.**
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Sincerely,*
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Dr.*Michael*L.*Thornton*&*Staff*
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Mansfield*Cosmetic*Surgery*Center*
[email protected]
8177477790003|3Office3
8177887759243|3Fax3
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Mansfield*Cosmetic*Surgery*Center*|*New*Patient*Welcome*Packet*
817>477>9000*|*www.mansfieldcosmeticsurgery.com*
About Us
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Mansfield*Cosmetic*Surgery*Center*was*established*in*2008*under*the*surgical*directorship*
of*Dr.*Michael*L.*Thornton,*a*fellowship>trained*Cosmetic*Surgeon*and*Diplomate*of*the*
American*Board*of*Cosmetic*Surgery.*Our*office*is*located*in*Mansfield,*Texas,*and*we*serve*
clients*from*Mansfield,*Arlington,*Fort*Worth,*Dallas,*and*the*surrounding*cities*of*North*
Central*Texas.***
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Our*3500*sq.*ft.*cosmetic*surgery*center*and*medical*spa*is*constructed*on*the*gorgeous*
Mediterranean>style*executive*office*property*of*the*Tuscan*on*Walnut*Creek,*located*in*
Mansfield.**Our*surgical*office*features*a*large*and*spacious*foyer*accented*in*Tuscan*
grandeur,*three*private*examination*rooms,*our*medical*spa*facility,*and*our*private*
operating*room.*
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During*your*complimentary*consultation,*Dr.*Thornton*will*personally*evaluate*your*
health,*conduct*a*private*physical*exam*and*explain*which*cosmetic*surgical*procedures*
are*most*appropriate*for*you*as*it*relates*to*your*unique*and*personal*circumstance.**Your*
private*cosmetic*surgery*consultation*is*booked*for*approximately*one*hour*and*Dr.*
Thornton*will*spend*as*much*time*necessary*to*establish*a*comprehensive*and*thorough*
physician>patient*relationship*with*you.*This*level*of*personal*attention*from*Dr.*Thornton*
is*what*defines*our*surgical*practice.**Although*well*qualified,*we*choose*not*to*use*a*
patient*coordinator,*nurse*practitioner,*or*physician*assistant*(PA)*to*perform*your*
consultation.*In*addition,*Dr.*Thornton*will*personally*see*you*during*every*post>operative*
visit*following*your*surgery*to*personally*aid*in*your*healing*process*and*provide*
physician>level*care.*
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Cosmetic*surgery*procedures*requiring*general*anesthesia*are*performed*at*Baylor$
Surgicare$at$Mansfield,*an*out>patient*AAAHC*certified*surgical*facility,*located*just*a*few*
miles*from*our*office.*However,*cosmetic*surgery*procedures*requiring*minimal*sedation,*
may*be*performed*in*our*own*private*operating*room.**Furthermore,*Dr.*Thornton*has*full*
cosmetic*surgery*and*general*surgery*privileges*at*the*Medical*Center*of*Arlington*to*
manage*any*post*surgical*difficulties.***
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Mansfield*Cosmetic*Surgery*Center*|*New*Patient*Welcome*Packet*
817>477>9000*|*www.mansfieldcosmeticsurgery.com*
About Dr. Michael L. Thornton
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Growing*up*in*Texas,*Dr.*Thornton*received*his*premedical*
Bachelor’s*degree*from*Baylor*University*and*received*his*
Medical*degree*from*the*UNT*Health*Science*Center*in*Fort*
Worth.*He*completed*a*comprehensive*five>year*general*
surgery*residency*through*Michigan*State*University*
affiliated*hospitals*at*Mount*Clemens*Regional*Medical*
Center*in*Mount*Clemens,*Michigan*and*completed*an*
additional*one>year*fellowship*in*Surgical*Critical*Care*and*
Trauma*Surgery*at*the*internationally*recognized*R*Adams*
Cowley*Shock*Trauma*Center*at*the*University*of*Maryland*
Medical*Center*in*Baltimore,*where*he*acquired*extensive*
knowledge*in*the*management*and*reconstruction*of*
complex*traumatic*injuries.*
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Following*a*creative*passion,*Dr.*Thornton*furthered*his*
surgical*expertise*by*completing*an*additional,*12>month*advanced*fellowship*in*Cosmetic*
Surgery,*accredited*and*recognized*by*the3American*Academy*of*Cosmetic*Surgery,*where*
he*gained*concentrated*knowledge*in*all*major*areas*of*cosmetic*surgery*including*facial*
plastic*surgery,*rhinoplasty,*cosmetic*breast*surgery,*liposuction,*body*contouring*surgery,*
non>surgical*aesthetics,*skin*care*rejuvenation,*and*laser*medicine.*
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Dr.*Thornton*is*a*Diplomate*of*the3American*Board*of*Cosmetic*Surgery*(ABCS),*which*is*
the*only*written*and*oral*certifying*board*that*exclusively*tests*knowledge*and*experience*
in*art*of*Cosmetic*Surgery,*and*he*is*currently*serving*a*3>year*term*as*an*oral*board*
examiner*for*the*ABCS.*In*addition,*he*is*dual>board*certified*by*the*American*Osteopathic*
Board*of*Surgery*in*both*General*Surgery*and*Surgical*Critical*Care*/*Trauma*Surgery.*
Because*of*Dr.*Thornton’s*three*board>certifications*and*surgical*dedication,*he*has*been*
bestowed*two*esteemed*honors*as*Fellow$in$the$American$College$of$Osteopathic$Surgeons$
(FACOS)*and*as*Fellow$in$the$American$Academy$of$Cosmetic$Surgery$(FAACS).*In*addition,*he*
has*over*14>years*of*combined*surgical*training*and*operative*experience*and*has*been*
named*“Top*Doc”*in*Fort*Worth,*Texas*Magazine,*in*the*specialty*of*cosmetic*surgery.*
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Dr.*Thornton*is*a*talented*and*compassionate*cosmetic*surgeon*and*his*philosophy*is*for*
you*to*achieve*a*natural*and*imperceptible*result*that*focuses*on*your*specific*goals,*while*
carefully*attempting*to*minimize*any*scars.*He*believes*your*cosmetic*surgery*is*only*
successful*when*you*are*happy*and*pleased!*
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Mansfield*Cosmetic*Surgery*Center*|*New*Patient*Welcome*Packet*
817>477>9000*|*www.mansfieldcosmeticsurgery.com*
Affordable Cosmetic Surgery
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Mansfield*Cosmetic*Surgery*Center*offers*options*for*affordable*cosmetic*surgery*by*
accepting*major*card*cards*including,*MasterCard,*VISA,*and*American*Express.*
In*addition,*we*are*pleased*to*offer*Care$Credit,*one*of*the*nation’s*leading*cosmetic*surgery*
payment*programs*making*it*easy*to*afford*cosmetic*surgery*procedures*you*desire.**With*
Care$Credit*you*may*finance*your*cosmetic*surgery*procedures*without*upfront*costs,*no*
annual*fees,*and*no*pre>payment*penalties.*So,*you*can*schedule*your*procedure*today*and*
conveniently*pay*over*time*with*low,*monthly*payments.*See*below*for*more*details*or*to*
apply*for*an*on>line*application*of*your*choosing.*
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Contact Us / Office Location
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Mansfield*Cosmetic*Surgery*Center*is*located*in*the*heart*off*Mansfield,*Texas*on*North*
Walnut*Creek*Drive,*just*west*of*Hwy*287*past*the*Walmart*and*United*Methodist*Church.**
To*better*assist,*you*may*click*the*“Contact*Us”*tab*on*our*website*and*follow*directions*
using*Google*Maps.**Please*contact*our*office*if*you*have*any*questions*locating*our*office.*
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Mansfield*Cosmetic*Surgery*Center*
550*N.*Walnut*Creek*Drive,*Ste*120*
Mansfield,*TX*76063*
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Office*Hours:*
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Monday*thru*Friday*
9am*–*5pm*
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Consultations*with*Dr.*Thornton*only*
Monday,*Wednesday,*and*Friday*
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Mansfield*Cosmetic*Surgery*Center*|*New*Patient*Welcome*Packet*
817>477>9000*|*www.mansfieldcosmeticsurgery.com*
Cosmetic Surgery Procedures
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FACIAL3COSMETIC3SURGERY3
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• Eyelid*Lift*Surgery*|*Blepharoplasty*
• Face*Lift*|*Neck*Lift*|*Mini*Face*Lift*
• Brow*Lift*
• Facial*Fat*Transfer*&*Grafting*
• Torn*Earlobe*Repair*|*Keloids*
• Surgisil*Permalip*Implant*|*Chin*implant*
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BODY3CONTOURING3SURGERY3
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• Abdominoplasty*|*Mini*Tummy*Tuck*
• Mommy*Make*Over*
• Liposuction*|*Laser*Liposuction*
• Brachioplasty*|*Arm*Lift*
• Brazilian*Butt*Lift*
• Hand*Rejuvenation*
• After*Weight*Loss*|*Post*Bariatric*Surgery*
• Abdominal*Hernia*Repair*
• Sclerotherapy*|*Spider*Vein*Injection*
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BREAST3COSMETIC3SURGERY3
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• Breast*Augmentation*
• Breast*Lift*
• Breast*Reduction*
• Breast*Revision*Surgery*
• Gynecomastia*|*Male*Breast*Surgery*
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MEDICAL3SPA3|3AESTHETIC3PROCEDURES3
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• CO2*Laser*Skin*Resurfacing*
• Botox®*|*Juvederm®*|*Radiesse®*|*Latisse®*
• IPL*|*Photofacial*
• Microdermabrasion*
• Chemical*Peels*|*Facials*
• Waxing*
• Permanent*Makeup*
• Obagi®*|*SkinCeuticals*
Mansfield*Cosmetic*Surgery*Center*|*New*Patient*Welcome*Packet*
817>477>9000*|*www.mansfieldcosmeticsurgery.com*
Mansfield Cosmetic Surgery Center
550 N. Walnut Creek Drive, Ste 120
Mansfield, TX 76063
New Patient Medical History - Cosmetic Surgery
Full Name
Date
Address
City
State
*Email address
Zip
SSN#
Home phone
Business phone/cell
Emergency Contact:
Name
Phone
Date of Birth
Age
Male
Female
Marital Status
Occupation/Employer
Race:
Ht
Caucasian
How did you hear about us?
African American
Hispanic
Friend
Internet
Magazine
Other
Reason for visit…why are you here today?
Who is your primary care physician?
Is a physician currently treating you?
List medication(s) you are presently taking:
Are you taking any of these specific medications?
Birth Control
Testosterone
NSAIDS / Aspirin
Steroids
Blood Thinners
Accutane
Vitamin E / Herbals
Thyroid
List allergies to medication(s):
Wt (lbs)
Asian
Other
Mansfield Cosmetic Surgery Center
550 N. Walnut Creek Drive, Ste 120
Mansfield, TX 76063
New Patient Medical History - Cosmetic Surgery
Do you have any of the following conditions?
AIDS
High blood pressure
Stroke
Anemia
Infection (active)
Thyroid problems
Arthritis
Keloid scars
Tuberculosis (TB)
Asthma / COPD
Kidney disease
Ulcers
Breast lumps
Liver disease
Venereal disease
Breast cancer
Lupus
Chemotherapy
Melanoma
Diabetes
Mental disorder
Weight loss: How much?_______________
Dizziness
Nervous disorder
Weight gain: How much?_______________
Epilepsy
Radiation treatment
Fainting
Respiratory disorder
Hay Fever
Skin conditions
Heart disease
Sinus problems
Hepatitis
Stomach problems
Please list any other medical conditions?
List all previous surgeries:
Smoking History:
Non-Smoker
Smoker
Quit
packs per day for
years ago.
years.
Do you drink alcohol?
List all family history (cancer, deaths, etc)
Females Only:
Number of children
Are you pregnant?
YES
NO
Are you breast feeding?
YES
NO
***Any other concerns or information we should know about you?
I have answered the above questions truthfully and will notify you of any changes in medications and physical conditions.
Patient Signature:
Date: