Patient Forms
Please take your time and fill out all these forms before you come for your appointment. That way, you’ll minimize your waiting room time, and maximize your meeting time.
For All Patients
Annual Consent
Patient Registration
Sharing Information
Smoking Consent
Consent to Photograph
Consent to Photo/Video/Interview
For Adult Patients
Comprehensive Health History
Comprehensive Health History Review of Systems
For Pediatric Patients
Comprehensive Health History
Financing
We want to make it as easy as possible for you to get the services you want, when you want to have them. That’s why The Center for Plastic Surgery at Sentara Martha Jefferson has partnered with CareCredit Financing Program.
CareCredit offers a variety of payment plans that allow you to finance up to $25,000 and spread the cost over several months. With CareCredit:
- The procedure fee does not increase, and most people who apply are approved.
- There are no up-front costs, no pre-payment penalties and no fees.
- You receive a revolving credit line so you can finance additional treatment without the need to re-apply.
It only takes a few minutes to apply for CareCredit, and you may receive an online decision in seconds. Apply now or see our staff for more details.