Information for New Patients and Required Forms
Please provide us with a picture ID to scan to our computer, as we request this of all patients. Also, for consultations to be submitted to an insurance company for payment, or if a prior authorization letter needs to go out for coverage of your procedure, please provide us with a copy of your insurance card. If the consultation is cosmetic, then there is a $75.00 consultation fee due at the time of your visit.
If you do not cancel or reschedule your appointment with at least 24 hours notice, we may assess a $75 “no-show” service charge to your account. This “no-show charge” is not reimbursable by your insurance company. You will be billed directly for it. After three consecutive no-shows to your appointment, our practice may decide to terminate its
relationship with you.
NEW PATIENT FORMS
Click on the document icon below to download a PDF of "New Patient Forms" and save time before your consultation.
How Did You Hear About Dr. Eckhardt?
Patient Data Sheet
Tips to Prevent Bruising after Wrinkle Reducers & Dermal Fillers
Notice Informing Individuals about Nondiscrimination and Accessibility Requirements