Welcome Packet & Forms
We are doing NO-TOUCH intake – please take pictures of all forms or fill out in Microsoft Word and send back to the practice.
TEXT your docs to Lauren at 804-929-0494
EMAIL your docs to Lauren@RichmondSurgicalArts.com
The forms include our Patient Information Sheet, History and Physical form, and HIPPA privacy notice.
Please bring the following with you to your first appointment:
- Driver’s License or Photo ID
- Insurance Card
- Referral, if necessary
- 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, Visa, MasterCard, American Express, and Discover. Directions to our office can be found at the bottom of this page. If we can be of any further assistance, please do not hesitate to contact our office at (804) 560-5260.
We look forward to meeting you!
* IF YOUR APPOINTMENT IS FOR A COSMETIC PROCEDURE, NO INSURANCE CARD WILL APPLY. COSMETIC CONSULTATION APPOINTMENTS ARE TYPICALLY ONE HOUR AND COMPLIMENTARY, HOWEVER A CREDIT CARD IS REQUIRED TO HOLD THE APPOINTMENT. IF YOU ARE UNABLE TO KEEP THE APPOINTMENT, A 24-HOUR NOTICE IS REQUIRED TO AVOID A FEE OF $75.
* 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.
These are all our digital forms. Please open them in MICROSOFT WORD, fill out and return or print documents, fill out and take a photo and send to the practice.