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Patient Forms and Payment

patient form

You should fill out the Patient Intake Form before you come in. Your surgeon can advise you if there are more forms you need to fill during or after your first appointment.

For all patients

  • Records Request Form This is the form that gives your surgeon permission to get your medical records.

For cleft lip and palate patients

Para pacientes con labio leporino y paladar hendido

Payment Options

We accept payment by cash, check or credit card. Unfortunately, no financing or loans are available.

For certain medically necessary procedures, we accept a variety of insurance plans. Call 443-997-9466 for more information. You can also contact your insurance company to find out if they cover specific procedures.

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