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Patient Forms

We look forward to meeting you, and to helping you achieve your aspirations of becoming your very best. Please click below, fill out our new patient forms, and bring them with you to your first appointment. Our patient forms may be viewed and downloaded by clicking the individual buttons below. Thank you!

PATIENT INFORMATION FORM

PATIENT HISTORY FORM

FINANCIAL RESPONSIBILITIES FORM

PHOTO RELEASE FORM

HIPPA FORM

PRIVACY AGREEMENT

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Financing & Insurance

From insurance to financing plans, we offer several options for payment. You will be given a quote in writing at your consultation appointment and at that time we will discuss with you all of our options including - “in house financing.” Financing is available through Care Credit, visit their website, call 1-800-365-8295, or you may reach out to Gina Brewer at 706-369-8440 for more information.

We accept cash, personal checks, and all major credit cards.

We are a preferred provider for most major insurance companies. If you have any questions regarding coverage, please call and ask to speak with our Insurance Coordinator. “Medically necessary” procedures (breast reduction, breast reconstruction, etc.) are often covered by insurance. Cosmetic procedures (breast augmentation, liposuction, abdominoplasty, etc.) are not covered by any insurance carriers.

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Policies

With our scheduling practices, we strive to keep the wait time to a minimum. We understand there may be times when you are not able to make your scheduled appointment and ask that you please give our office a 5 business day notice. Please note the office is CLOSED ON FRIDAYS. Our consultations are complimentary but we do require a major credit card to secure your appointment. We obtain this information at the time of your call and without this information, we will not be able to schedule your consultation appointment. Please note there will be a $75 consultation fee if you are a NO SHOW to your appointment or cancellation of your appointment is made less than 5 business days. NO SHOW fees are the patient’s responsibility and insurance companies will not cover this fee.

PRIVACY AGREEMENT