Elliot Health System Plastic & Reconstructive Surgery: Patient Information

Our patient service representative will speak with you on the phone to better understand your plastic surgery needs and obtain some basic information to schedule your appointment. When you arrive at your appointment, you will be asked to fill out some information, including a questionnaire regarding your medical health. Our medical assistant will greet you in the waiting area and take you to one of our exam rooms. We will take your vitals and ask you a few preliminary questions. If needed, you will be asked to change into a gown. Our surgeon, nurse practitioner, or physician assistant will then come in to discuss your plastic surgery needs. After your visit, a member of our team will schedule your next appointment, if necessary, and print out a summary of your visit. If a cosmetic quote is needed, our surgical scheduler will review the financial details with you. After your visit, you will be brought back to the waiting room.

Reconstructive Surgery – Our patient service representative will make a copy of your insurance card at the initial visit. After your consultation, our surgical scheduler will submit your file to your insurance company for prior authorization.

Cosmetic Surgery – Our patient service representative will make a copy of your insurance card at your initial visit. Cosmetic surgery is not covered by insurance, so your insurance company will not be billed unless it is determined that part of your surgery is covered by your insurance company. A consultation fee will be collected at the time of your first consultation with the surgeon. A cosmetic quote will be provided on the day of your initial consultation. If you would like to proceed with surgery, a $750 deposit is needed to reserve your surgery date. The balance will be collected three weeks prior to surgery. We accept cash, cashier’s check, Visa, Mastercard, American Express, and Discover. At this time, we do NOT accept personal checks. We do NOT accept Health Savings Accounts.

To schedule, cancel, or reschedule an appointment, please call our office at 603-314-6450 or log into your MyChart account. If you do not have a MyChart account, please click here to sign up. 

Insurance Card, including your policy number and/or Medicare/Medicaid card.

Co-payment is expected when you check in. For your convenience, we accept checks, cash, Visa, Mastercard, Discover, and American Express.

Prescription Medication(s) in their original bottles or a list of all medications, including over-the-counter medications, vitamins, and supplements, and the amounts you take.

To refill a prescription, please call our office at 603-314-6450 or log into your MyChart account. If you do not have a MyChart account, please click here to sign up.

Please allow 48 hours to refill medications.

To request a referral, please call our office at 603-314-6450 or log into your MyChart account. If you do not have a MyChart account, please click here to sign up.

If you would like a copy of your medical record, please download and complete the form below. Completed forms can be mailed, faxed, or brought back to our office.

Medical Records Release Form