Preparing for your visit should be simple and convenient. Our patient forms are available online so you can complete the necessary paperwork before your appointment, allowing more time to focus on your consultation and care.
Patient Forms
What to Know Before You Visit
At James Bruno Plastic Surgery, we aim to make every step of your experience organized, efficient, and patient-centered. The forms listed below are required for patients undergoing reconstructive procedures or consultations that involve insurance coverage. Each document is designed to ensure that your information is accurate, your privacy is protected, and your care is coordinated appropriately. You may download and complete these forms at your convenience before your appointment. If you have any questions while reviewing the documents, our team is happy to assist you.
Required Patient Forms
New Patient Forms
These forms provide essential background information about your health history, current medications, and personal details. Completing them in advance helps our team prepare for your consultation and ensure safe, personalized care.
Financial Policies for Reconstructive and Insurance-Covered Procedures
This document outlines our financial policies related to reconstructive procedures that may involve insurance coverage. It explains billing practices, patient responsibilities, and important information regarding insurance claims and payment expectations.
Patient Demographic Sheet
The demographic sheet collects basic information, including contact details, insurance provider information, and emergency contacts. This ensures our records remain accurate and up to date.
HIPAA Notice to Patients
This document explains how your personal health information may be used or shared and outlines your rights under federal privacy regulations. Protecting patient confidentiality is a priority for our practice.
HIPAA Acknowledgment of General Notice
By signing this form, patients confirm that they have received and reviewed the HIPAA privacy notice provided by our office.
Authorized Representative Form
This form allows you to designate a trusted individual who may assist with communication regarding your care, medical records, or insurance information if needed.
Aetna® Authorized Representative Request Form
Patients with Aetna insurance may complete this form to authorize a representative to communicate with the insurance provider regarding claims or coverage.
UnitedHealthcare® Designation of Authorized Representative Form
This form provides similar authorization for patients covered by UnitedHealthcare, allowing a designated representative to assist with insurance-related matters.
Why Choose James Bruno Plastic Surgery
At James Bruno Plastic Surgery, every patient is treated with thoughtful, individualized care. Our team takes the time to listen, understand your goals, and guide you through each step of your experience with clarity and support. Patients appreciate the calm, discreet setting of our practice, where comfort and privacy are respected. From consultation through recovery, the focus is on helping you achieve natural, refined results while feeling supported and confident in your care.
