Patient Center Forms, Brochures, Articles, FAQ, Pre and postoperative guidelines &Financing Applications!
Welcome to our patient center! Because we are Joint Commission Accredited we require more than the average Office does in paperwork . While this may be cumbersome and seem like a burden to you, we value our commitment to outstanding and safe surgical care. Dr Jeneby has spent almost 1000 hours becoming accredited for the sole purpose of providing a safe environment for you and your loved one. Please enjoy the patient Center forms, brochures and downloads!
Please log into your account from home by going to:
Forms for your visit:
(all need to be completed prior to visit and brought to the center or this could delay your appointment)
Form 1: Wishlist
Form 2: Patient Demographics
Form 3: History and Physical
Form 4: Initial Learning Assesment
Form 5: Media Release
Form 6: Cash or Finance Agreement
Form 7: Financial Lawsuit and/or Dispute
Form 8: Patient Acknowledgement
Form 9: Patient’s Bill of Rights
Form 10: HIPAA Notice of Privacy Practices
Form 11: Disclosure Information
General Topics to visit:
Financing (In house application). We have another option to finance your surgery. For a 100$ fee we will take 65% down for non –implant procedures and 75% down for implant procedures and finance the rest. Bring or email/fax a voided check and the front and back of a credit /debit card to firstname.lastname@example.org or email@example.com or your coordinators.
Preoperative info: Preop admission, Preop Shopping list, General Preop orders, Healing mind, Medications to avoid, Physician Patient Agreement, Web Defamation Agreement
Postoperative info: General Postop Instructions , Breast Exercises, Surgery Related Post-op Instructions
Breast Augmentation, Abdominoplasty, Liposuction, DOT etc.