To schedule an appointment, call 804.585.3420

Patient Forms

Save time on your first visit. Download these forms, complete and bring with you so we will be able to see you sooner.

Registration Form [Download]

Complete this form to let us know about you. Bring it with you when you come for your consultation and we can immediately get you ready to see the physician. Please also bring a copy of your insurance card with you on the day of your appointment. We will put a copy of this in the chart so that we can check to see if any of your visits/procedures are covered and file your insurance for you.

Acknowledgement Form [Download]

Here at Richmond Plastic Surgeons, Inc., we are compliant with the HIPAA privacy act and have copies of it available for you at our office. To read the HIPAA privacy act online, click here. After reading the policy, download and sign the Acknowledgement Form and bring it with you the day of your appointment.

Disclosure Form [Download]

We value your privacy and are bound by law to not release any information about your care or any other information about you without your consent. If you would like us to be able to discuss your care with your spouse, children, parents or anyone else, please provide their information on this form. If this is not completed we will be unable to talk to anyone about you except you.

Patient Financial Policy [Download]

HIPPA Notice of Privacy Practices [Download]