Patient Resources

Patient Forms

You can accelerate your check in process by downloading, printing, and completing the Patient History and Account Registration forms. If you are coming in for a breast augmentation, reduction, or lift, then you will also want to fill out the Breast Sheet.

If you need help completing these forms, have questions regarding a consult, or would like to set up a consult, contact us.

• Patient Registration
• Patient History
• Breast Sheet
• Implant Information
• Decision Checklist
• Notice of Privacy Practices
• Release of Medical Records
• CoolSculpting Consent Questionnaire
• Good Faith Estimate
• Surprise Billing
• Referral to Ambulatory Surgery Center
• Medically Managed Weight Loss Intake Form

Financing

Having a cosmetic procedure is an investment in yourself - both how you look and how you feel. If you would like to make a change in your appearance, but are worried about the cost, EK Plastic Surgery can provide you with information on financing options to help you on your journey.

Care Credit is a simple way to consolidate and manage your cosmetic surgery expenses. Care Credit offers various options with differing terms, interest rates and payment options. Explore what is available through Care Credit’s convenient website.

Care Credit can be utilized for portions of all procedures offered at EK Plastic Surgery. Call for more information on details and restrictions. If you have questions about financing and using Care Credit, please contact us online or call 563-589-9119.

Preparing for your surgery

Dr. Kennedy and the EK Plastic Surgery team want to make sure you are as informed and prepared as possible for your surgery. Please visit the link below for information to help you Before Your Surgery, on the Morning of Surgery and After Surgery. You will also find additional information on prescriptions you may be given; anesthesia and possible risks and complications.

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Insurance Coverage

If you are considering surgery and are interested in learning more about coverage through your health insurance, contact us.

To help determine your benefits, please provide the following:

• A copy of both the front and back of your insurance card
• The patient's name and date of birth
• The subscriber's name and date of birth

This information can be faxed to EK Plastic Surgery at 563-552-2800 or sent through e-mail to office@ekplasticsurgery.com.