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1129 East 2nd Street Casper, WY 82601

   Call Us (307) 234-4585

For your convenience, we have provided commonly used plastic surgery forms below so you may save time at the office. Please download, print and fill out the forms prior to your consultation with Dr. Roussalis.



Please feel free to contact the office with any questions or if you need any help or assistance filling out these forms. In order for us to do the best and most thorough job for our patients, it’s important that we have all the information requested on these forms. It is our duty to know and understand our patients and their medical history so that we may protect them and offer them the best and most sound medical opinion and advice possible.

If you have any technical challenges with these forms or logging in please let us know.

At the offices of Dr. John L. Roussalis we respect your privacy and your connection to our patient login portal is secure. Our process of gathering your history and information is secure and state of the art. It is our duty as medical professionals to always keep your information confidential and secure. You can trust Dr Roussalis and his staff to protect your right to privacy.