New patients will need to fill out patient information, patient history and insurance forms. We have included these standard forms below. Please print and fill out each form prior to coming in. You will need Adobe® Acrobat® Reader™ — a plugin is available from Adobe.
- New Patient Cosmetic Consultation Forms
- Laser Medical History Form
- Artic Peel Consent
- Arctic Peel Pre Post Instructions
- Laser Hair Reduction Consent
- Laser Hair Removal Pre Post Instructions
- Laser Vein Treatment Consent
- Laser Vein Treatment Pre Post Instructions
- Rhinoplasty Pre Post Instructions
As you consider cosmetic surgery you may be wondering about your payment options. There are a number of payment options. We offer an array of programs designed to meet your individual needs.
Types of Payments
- Cash or Check: Personal check, cashier’s check, or cash.
- Credit Cards:Visa, MasterCard, Discover, or American Express.
Patient Payment Plans:
We offer a number of financing options. For financial assistance, call Jenny at (888) 455-FACE or email her at, jroach@PICosmeticSurgery.com. Jenny is our financial counselor and has worked with Premier Image Cosmetic & Laser Surgery for over 10 years. She can guide you in choosing the best options, as well as, the pre-screening process that will not affect your credit. She has helped many patients achieve their dreams with payment plans that fit comfortably in their budgets.
We offer No Interest (same as cash) payment plans for up to 12 months. We also offer extended payment plans for 24, 36, 48 or 60 months with varying rates of interest depending upon your credit history.
Dr. Marc Klein participates in the following insurance plans:
- United Health Care
- Blue Cross/Blue Shield.
For cases covered by insurance, all co-pays are due at time of service.
Insurance Coverage for Rhinoplasty
Insurance usually covers functional problems such as breathing obstruction, repeated nasal or sinus infections, or intermittent nasal bleeding. Rhinoplasty (nose job) is considered cosmetic surgery and insurance will not cover the cosmetic part. However, many patients have physical problems associated with their nose and desire cosmetic changes. Insurance will cover the portion of the medical problem but not the cosmetic part of the surgery. It is important to check with your insurance carrier to determine their policy pertaining to nasal surgery prior to surgery.
Insurance Coverage for Breast Surgery
Breast reconstruction after mastectomy is covered, and this coverage is now actually required by law. Large breasts often cause moderate to chronic pain and insurance often covers those cases.
Blepharoplasty (Eye lid surgery)
In most cases, insurance does not cover eyelid surgery and considers it cosmetic in most cases. However, patients with a severely hooded eye lid which impairs or obscures vision can sometimes be covered or partially covered by insurance. The insurance companies usually require a vision objective test, typically done by an ophthalmologist. Also, documented photos of eyelid droop or dermatochlasia (excess skin above the eyelid) are also required. Insurance companies never cover lower lid surgeries.
Have the Procedure Now, Pay For It Later!
Premier Image Cosmetic & Laser Surgery offers 12 month financing through CareCredit™. Have the cosmetic procedure you want now and pay for it over the next year. There’s no interest if the entire balance is paid off by the end of the 12 month period.
Look your best – feel your best with the CareCredit™ card. Best of all, CareCredit™ offers convenient payment plans and no hidden costs. You can even use your CareCredit™ card for follow up appointments.