Patient
Information

Step 1: Patient Intake

Downloadable Patient Forms

Complete these forms in advance to save up to 20 minutes at check-in. You can download and print the PDFs, or use our digital patient portal to submit them securely online.

Form Name & Purpose

Before Visit?

Digital Portal?

Format

Action

New Patient Registration

Basic demographics and intake details required for entry

Medical History Intake

Comprehensive review of past conditions, medications & allergies

Insurance Verification

Provider details required to process pre-authorizations

HIPAA Consent Form

Acknowledgement of patient privacy & medical data rights

Financial Responsibility Agreement

Understanding of co-pays, billing deadlines & insurance claims

Specialist Referral Intake

Required only if referred by an external primary care doctor

Step 2: Payment & Coverage

Insurance, Financing & Billing

We strive to deliver exceptional healthcare while keeping your budget in mind. Learn about accepted insurances, flexible installment plans, and how to reach our billing department.

Insurance & Co-Pays

We are in-network with a majority of private PPO dental and medical plans. Our team handles complete claim submissions for you. Co-payments, co-insurance, and deductibles are due at the exact moment of your appointment.

Financing & Self-Pay

For uninsured patients or extensive treatment plans, we offer convenient interest-free financing up to 24 months through CareCredit. We accept cash, check, and all major credit cards.

Billing & Cost Audits

Have questions about a prior charge, an outstanding ledger balance, or a complex insurance Explanation of Benefits (EOB)? Our dedicated in-house billing team is available for real-time support.

Step 3: Arrival Prep

Pre-Appointment
Checklists

To make your visit seamless and safe, review this vital preparatory checklist before you arrive at our clinic.

Bring a Valid Photo ID

A state-issued driver’s license, military ID, or official passport is required to authenticate patient medical records.

Arrive 15 Minutes Early

Please plan to walk in 15 minutes before your treatment slot to process identity checks and coordinate insurance updates.

Present Your Physical Insurance Card

We require a physical or verified digital copy of your current active card at every single appointment.

Provide a Detailed Medication List

Document precise names, active dosages, and frequencies for all prescriptions, vitamins, and supplements.

Complete Forms Prior to Arrival

Filing your registration and medical intake forms online ensures immediate medical clearance upon checking in.

Practice Guidelines

Our Practice & Office Policies

Consistent clinical guidelines help us maintain safe, reliable, and exceptionally punctual healthcare schedules for everyone.

ⓘ 24-Hour Cancellation Policy

We reserve dedicated time slots specifically for each patient. If you must reschedule or cancel, notify us at least 24 hours in advance to avoid a standard $50 short-notice fee. Exceptions are made for sudden medical emergencies.

ⓘ Insurance & Co-Pay Policies

It is the patient’s responsibility to verify active in-network status with their insurance provider prior to consultation. All individual co-pays must be paid at the desk during checkout; unpaid ledger balances incur billing fees.

ⓘ Late Arrival Policy

If you are running late, please contact our front desk immediately. Appointments delayed by 15 minutes or more may need to be rescheduled or compressed to preserve the schedule integrity for subsequent patients.

ⓘ Privacy & HIPAA Compliance

Your private medical information is safeguarded in strict accordance with federal law. Personal records, diagnostic scans, and clinical histories are completely encrypted and never shared without active consent.

Step 4: Connect With Us

Have Questions? We are Here to Help

Reach our administrative coordinators via phone, email, secure medical fax, or visit our central clinic location.

Contact Information & Hours

Operating Hours

Monday – Thursday

8:00 AM – 5:00 PM

Friday

8:00 AM – 3:00 PM

Saturday

9:00 AM – 1:00 PM (By Appointment Only)

Sunday

Closed

Ballantyne Plastic Surgery

14135 Ballantyne Corporate Pl

#150, Charlotte, NC 28277

PatientInformation