Download Forms

All new patients need to complete new patient paperwork. For your convenience, the forms are available for download. Print, complete and bring the forms to your appointment Get Adobe® Acrobat®.

PDFPersonal Information
Download PDF 721k

PDFConsent for Treatment
Download PDF 834k

PDFMedical History
Download PDF 859k

Patient Payment

Some payments are due at your office visit. These payments could include:

  • Co-payments, deductibles and coinsurance
  • Fees for procedures that are not covered by insurance, including aesthetician services and skin care products
  • Deposits for cosmetic/elective procedures
Additional Charges

There may be additional charges posted to your account after you leave our office. These charges would be for services rendered during your visit which had not been entered into the billing system at the time of your departure. Cash, personal checks, American Express, VISA, MasterCard and Discover are accepted.

If we are a participating provider on your insurance plan, claims will be filed to the insurance company directly. In the event that your insurance company denies payment for any reason, patients or their guarantors are responsible for payment of all outstanding charges for services rendered.

If you are unable to make your appointment and neglect to notify us at least 24 hours in advance, you will be billed accordingly: $25 for office visits and $50 for surgery.

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