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Patient Forms
The forms below are available to be downloaded, printed and filled out.
Consultation
In your initial consultation, Dr. Snyder will meet with you in Rapid City and discuss your personal cosmetic surgery goals. She will then help you choose the most appropriate procedure and spend time to make sure you are well informed and feel comfortable about the proposed surgical plan.
The cosmetic consultation fee for Dr. Snyder is $75, which will be applied toward the cost of surgery, if scheduled. Reconstructive consultation fees will be billed to your insurance company, but co-pays and deductibles are due at the time of service. It is your responsibility to check that any required referrals from your primary care physician are sent to our office before your appointment.
Financial Policy
Reconstructive Patients
We are committed to providing you with the best care possible. If you have medical insurance, we will help you receive your maximum allowable benefits. In order to achieve these goals we need your assistance. Please carefully read our financial policy. We will be happy to answer any questions you may have. If we participate with your insurance company, claims for all services provided will be submitted to your insurance provider, unless the insurance company has informed us that your procedure is not covered by your insurance policy. All co-pays, co-insurances and deductibles are your responsibility and due at the time of your office visit and/or 2 weeks before your scheduled surgery.
If we do not participate with your insurance company, as a courtesy we will submit the claim for surgery on your behalf to your insurance company, but we do not accept payment from them as payment in full. You are responsible for your out-of-network deductible, co-insurance and any balance remaining. Payments for office visits are due at the time of service and surgical payments are due 2 weeks prior to your surgery.
Some reconstructive procedures require pre-authorization from your insurance carrier. Our office is pleased to provide this service following your consultation. The authorization process may take 4 to 6 weeks. Surgery will not be scheduled until the authorization is received, and all co pays/deductibles are due two weeks before your surgery date. Your insurance policy is a contract between you and your insurance company and your specific benefits may vary. Some policies do not cover certain procedures.
If you do not have medical insurance, we will gladly discuss your options and assist you in obtaining financing.
Cosmetic Patients
We will be happy to provide you with an estimate of costs for cosmetic surgery over the phone before your consultation. Specific fees vary based on the complexity of your individual surgery, and you will be given an individualized quote at the time of your consultation, which will be valid for one year. Surgery will not be offered to you or scheduled without first being seen in the office for consultation.
The payment for cosmetic surgery procedures is due in full at least 2 weeks before the date of surgery. We accept cash, checks, and most major credit cards. If you are having difficulty obtaining your own financing, we will be glad to assist you in locating lenders that are available for the cosmetic client and assist you with the application process. We currently participate with the following lenders:
