Patient Resources

Patient Forms

Once you have made your initial appointment, you may pre-register by downloading, printing, and completing the form below. Completing the form prior to your visit will help speed up the new patient registration process.

New Patient Form

Please note: It may take a few minutes to load the forms if you are using a slow internet connection. If you are unable to view the forms, you may need to download Adobe Acrobat for free by clicking on the icon below.

Get Adobe Reader

Financial Policy

Cosmetic Patients

We will be happy to provide you with an estimate of costs for cosmetic surgery over the phone before your consultation. Specific fees vary based on the complexity of your individual surgery, and you will be given an individualized quote at the time of your consultation, which will be valid for six months. Surgery will not be offered to you or scheduled without first being seen in the office for consultation.

Payment for cosmetic surgery procedures is due in full at least 2 weeks before the date of surgery. We accept cash, checks, and most major credit cards. 

If you are having difficulty obtaining your own financing, we will be glad to assist you in locating lenders that are available for the cosmetic client and assist you with the application process. We currently participate with the following lenders:

CareCredit®

Reconstructive Patients

We are committed to providing you with the best care possible. If you have medical insurance, we will help you receive your maximum allowable benefits. To achieve these goals, we need your assistance. Please carefully read our financial policy. We will be happy to answer any questions you may have.

If we participate with your insurance company, claims for all services provided will be submitted to your insurance provider, unless the insurance company has informed us that your procedure is not covered by your insurance policy. 

All co-pays, co-insurances, and deductibles are your responsibility and due at the time of your office visit and/or 2 weeks before your scheduled surgery.

If we do not participate with your insurance company, as a courtesy we will submit the claim for surgery on your behalf to your insurance company, but we do not accept payment from them as payment in full. 

You are responsible for your out-of-network deductible, co-insurance, and any balance remaining. Payments for office visits are due at the time of service and surgical payments are due 2 weeks prior to your surgery.

Some reconstructive procedures require pre-authorization from your insurance carrier. Our office is pleased to provide this service following your consultation. The authorization process may take 4 to 6 weeks. Surgery will not be scheduled until the authorization is received, and all co pays/deductibles are due 2 weeks before your surgery date. 

Your insurance policy is a contract between you and your insurance company and your specific benefits may vary. Some policies do not cover certain procedures.

If you do not have medical insurance, we will gladly discuss your options and assist you in obtaining financing.

Request a Consultation

Request a Consultation

Black Hills Plastic Surgery