Patient Registration

For your convenience, you can fill out the patient registration form online

Doctores Juan Pablo and Jacqueline Aragón, Patient Registration

Patient Registration

Your initial patient registration is the first phase of your surgical care experience at Plástica Surgical Care. For your convenience fill out the patient registration form online.

    Today's date

    Reason for Consultation

    Personal Information

    Full Name (required)

    Date of Birth


    Home Phone

    Mobile Phone


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    Next of Kin Information

    Full Name


    Mobile Phone


    Referral Information

    How did you hear from us?

    Referred by

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    Dr. Cervantes and Dr. Aragón of the Plástica Tijuana Surgery team are dedicated to you as an individual. They listen to your goals, make sure you understand your options and recommend only proven procedures that address your specific needs.

    We welcome you to contact us to learn more about your cosmetic surgery, reconstructive surgery and facial procedures options or to schedule your personal consultation with board-certified plastic surgeons Dr. Cervantes and Dr. Aragón. Plastic Surgery in Tijuana proudly serves patients in Los Angeles County, San Diego County and Baja California, areas.