Patient Forms
- Authorization & Release for Photos
- Cosmetic Interest Questionnaire
- Health History
- HIPAA Notice of Privacy Practices
- Message Authorization & HIPAA Acknowledgment
- Patient Information
- Patient Rights and Responsibilities
- Payment Policy
Patient Referral Program
Happy patients are undoubtedly our best source of new patients.
Dr. Cassidy Mitchell would like to thank his patients who refer their friends for surgery with a $500 credit toward a future plastic surgery procedure.
Here are the guidelines for our Patient Referral Program:
- The referred patient must use your full name when scheduling the consultation appointment.
- The patient must complete surgery within six months of the initial consultation.
- You will receive a $500 credit for each referral meeting the above criteria. All credits can be applied to a single cosmetic surgery over $2,000.
- The $500 credit cannot be combined with any other discount.
- Referral credit can be applied to Dr. Mitchell’s fee only; hospital and anesthesia costs are the patient’s responsibility.
- Credits can only be used for future surgeries; they cannot be applied as a payment on an outstanding balance from a previous surgery.
- Referral credits are not transferable. Referral credits can only be used by the referring patient.
- This program applies to new patients referred after March 1, 2011.
Many of our patients have been generously rewarded through this program.
If you have any questions about the Patient Referral Program, please call us at 402-483-8530.