Patient Forms


Get ahead of the game and reduce waiting time.

rps NEW PATIENT FORM

Your comfort and satisfaction is our goal; we pride ourselves in educating guests. To best achieve this we would like to know about you and your lifestyle. Required for new patients.

Download PDF

 

RPS HIPPA

A statement regarding the Health Insurance Portability & Accountability Act of 1996. Required for new patients.

Download PDF

 

rps questionnaire

Information about your referral source and goals. Required for new patients.

Download PDF

 

CREDIT CARD AUTHORIZATION FORM

Authorize Spa Renaissance & Renaissance Plastic Surgery to make a one-time transaction to your credit or debit card.

Download PDF