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(614) 682-5095

Online Forms

As an added convenience to our new patients, we offer online versions of our registration documents to be printed out and completed prior to your appointment. Doing so will expedite the registration process, saving time on the day of your visit. Please print and complete each form and bring the finished documents with you to your appointment. Please note, Adobe® Acrobat® Reader™ is required to view and download all documents.

You can also find several procedure forms here. If you do not find what you are looking for, please contact our office.

What Our Patients Are Saying…

If I could rate 10 stars I absolutely would! Dr. Bernacki recently performed a breast augmentation on me and I am so completely in love with the results! Seriously, life changing for me! I was treated with the utmost respect and Dr. Bernacki has a wonderful, caring bedside manner. He...
- Shelby L
I was very nervous because surgery is new to me. Dr. Bernacki is a wonderful surgeon and I will definitely refer him. Thank you!
- Becky G
After years of neck pain, shoulder pain, and back pain it's finally gone! I researched plastic surgeons and looked at reviews for a good 2 years before deciding to make the trip to get an consultation from Dr. Bernacki for a breast reduction which was almost a two hour drive....
- Rebekkah C
I'm a current patient. Staff and Dr. Bernacki are amazing. Very thoughtful and extremely kind. Dr. Bernacki is reconstructing my breasts from my Bilateral double mastectomy. And along the way I have hit a few bumps in the road. He and his staff are very supportive. Every single question I've...
- Jacealynn
Dr. Bernacki is an incredible surgeon with a wonderful bedside manner. I am so pleased with my results and will be recommending him to all my friends and colleagues.
- Anne C