Welcome!

You recently made a new patient appointment to see Dr. Lynam. On our web-site are the new patient forms that you can print, fill them out, and bring them with you on the day of your appointment. The forms include our patient information sheet, History and Physical form, along with our HIPPA privacy notice.

You will need to bring the following:

1. Drivers License or Photo ID
2. Insurance Card
3. Referral, if necessary
4. If the patient is a child their Social Security number is required.

Richmond Surgical Arts, Inc. also requires that all fees be paid at the time of your visit. We accept cash, check, and most major credit cards, EXCLUDING American Express and Discover. Directions to our office are also on our web-site. If we can be of any further assistance, please do not hesitate to contact our office at 560-5260.

We look forward to meeting you!

* IF YOUR APPOINTMENT IS FOR A COSMETIC PROCEDURE, NO INSURANCE CARD WILL APPLY

* IF YOUR APPOINTMENT IS FOR A LESION REMOVAL, REMEMBER, YOUR FIRST VISIT WILL BE A CONSULTATION ONLY. YOU WILL THEN BE SCHEDULED FOR THE ACTUAL REMOVAL ON YOUR SECOND VISIT.

Patient Forms

Download Adobe Reader here to view the following documents.

 

Patient Information Sheet
Patient Registration Form
Written Acknowledgement Form

Skin Rejuvenation Center

Skin Rejuvenation Information Sheet

Skin Rejuvenation LaRoche-Posay/Biomedic Form

Skin Rejuvenation Writen Acknowledgement Form

 

Vaser

MC1 Informed Consent Form

Vaser Pregnancy Consent Form