Patient Forms

Access new patient forms and other informational documents for your convenience. Download the forms you need before you arrive at the Advanced Center for Plastic Surgery so we can get started on your journey immediately.

Patient Registration Form 

This form is to be filled out by the patient. It consists of basic contact info, past and present medical history, and insurance information. This form also includes a copy of our financial policy and a photography consent form if the patient wishes to have photographs taken before/after surgery. Download the form here. 

HIPAA Patient Form  

This notice describes how medical information about you may be used and disclosed and how you can access that information. Please review this document carefully. Download this form here. 

Notice to Patients 

This notice describes how medical information about you may be used and disclosed. We are required by law to protect the privacy of your protected health information. This document also explains how you can gain access to your medical information and who to contact if you have any complaints. Please read the document carefully and sign the bottom of the form to acknowledge that you have received it. Download the notice here.  

Financial Policy 

Please review the following financial policies. To ensure that all patients adhere to our policies, the following form must be signed and dated by both the patient and a witness. By signing this form, both patient and witness attest that the policy has been fully read, understood, and agreed upon by the signing patient. Download the policy here.  

Insurance 

The Advanced Center for Plastic Surgery does not participate with insurance but provides pre-authorization paperwork for patients to submit once surgery has been completed.  

Patient Rights and Responsibilities 

This document details a list of every patient’s rights & responsibilities, as well as contact information for questions and/or grievances. This document should be read in full and then signed by the patient to acknowledge their understanding of the information. Download here. 

See what our patients have to say.

"I don't think that I can say enough positive things about Dr. Fischer and/or her team. The ACPS is amazing; the care they offer their patients is honestly unparalleled. They value you as a person, not a "paycheck." They take the time to talk with you and get to know you, are always incredibly helpful, and are so flexible. Dr. Fischer's bedside manner is amazing, and she is genuine and incredibly kind. She cares about doing a good job and bringing your vision to life. If she misses a mark, she puts in the effort to make it right and make you happy, comfortable, and confident. 10/10 recommend without reservation."

Benjamin

"Extremely personable and caring staff; everyone here has been very helpful and supportive throughout my care here. I could not have asked for a more thorough and comfortable experience here!"

Casimir

"Dr. Fischer and her staff are knowledgeable, friendly, welcoming, and, most importantly, affirming & validating at all times. They also have carefully curated resources and information to support clients and their family members in better understanding Gender Affirmation and Gender Identity. My recovery was seamless, and their care and support continued long past the surgery date. I cannot say enough good things about Dr. Fischer's practice, you will be in excellent hands when you see her!"

Eamon