25th Anniversary Sale

Patient Forms

The following can give you some helpful details about our office policies, as well as downloadable forms to help you save time should you decide to visit our practice for a consultation with Dr. Keusch.

If you have any questions or concerns, please contact us and we will be happy to speak with you.

Patient Forms

In order to reduce the time you spend waiting in our office, Dr. Keusch has provided several forms that can be completed online. These forms are secure, so that only Dr. Keusch may view the information on them. Please print the below forms. Complete the forms and bring them with you on your first visit. Please click the following button to access new patient forms.



“I had lived with terrible scars from treatment for skin cancer. My friend recommended that I go see Dr. Keusch, I am so thankful that I took her advice.”*

“Dr. Keusch took the time to answer all of my questions concerning the procedure that I want to have, she explained to me and my husband the realistic results that I should expect, what a difference.”*

“After having my breasts removed I made an appointment with Dr. Keusch. She took the time to explain all of the options that were available and recommended the procedure that would give me the best possible results for my situation. That has been several years ago. Now she is going to do my eyes!”*