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Patient
Information

Board certification and professional membership badge
Board certification and professional membership badge
Ballantyne Plastic Surgery – Charlotte, NC
Ballantyne Plastic Surgery – Charlotte, NC
Ballantyne Plastic Surgery – Charlotte, NC
Step 1: Patient Intake

Downloadable Patient Forms

Complete these forms in advance to save up to 20 minutes at check-in. You can download and print the PDFs, or use our digital patient portal to submit them securely online.
Form Name & Purpose
Before Visit?
Digital Portal?
Format
Action
New Patient Registration
Basic demographics and intake details required for entry
Required Before
Online Intake
PDF
Download
Medical History Intake
Comprehensive review of past conditions, medications & allergies
Required Before
Online Intake
PDF
Download
HIPAA Consent Form
Acknowledgement of patient privacy & medical data rights
Required Before
Online Intake
PDF
Download
Financial Responsibility Agreement
Understanding of payment policies, billing deadlines & financing options
At Check-In
Online Intake
DOC
Download
Specialist Referral Intake
Required only if referred by an external primary care doctor
At Check-In
In-Person Only
PDF
Download
Step 2: Payment & Coverage

Financing & Billing

We strive to deliver exceptional care while keeping your budget in mind. Learn about our payment policy, flexible financing options, and how to reach our billing department.

Self-Pay Practice

Ballantyne Plastic Surgery does not accept insurance. All procedures are self-pay, and payment is due at the time of service. Our team is happy to review costs with you during your consultation.
  • All major credit cards accepted
  • 10% courtesy discount for upfront fully self-paid procedures

Patient Financing Options

We partner with trusted patient financing providers so you can plan your treatment with flexible monthly payments. Apply online through any of the options below.

Billing & Cost Audits

Have questions about a prior charge, an outstanding balance, or your financing options? Our dedicated in-house billing team is available for real-time support.

Step 3: Arrival Prep

Pre-Appointment
Checklists

To make your visit seamless and safe, review this vital preparatory checklist before you arrive at our clinic.

landing-page-mommy makeover – Ballantyne Plastic Surgery

Bring a Valid Photo ID

A state-issued driver’s license, military ID, or official passport is required to authenticate patient medical records.

Arrive 15 Minutes Early

Please plan to walk in 15 minutes before your treatment slot to process identity checks and complete any remaining paperwork.

Provide a Detailed Medication List

Document precise names, active dosages, and frequencies for all prescriptions, vitamins, and supplements.

Complete Forms Prior to Arrival

Filing your registration and medical intake forms online ensures immediate medical clearance upon checking in.
Practice Guidelines

Our Practice & Office Policies

Consistent clinical guidelines help us maintain safe, reliable, and exceptionally punctual healthcare schedules for everyone.

ⓘ  24-Hour Cancellation Policy

We reserve dedicated time slots specifically for each patient. If you must reschedule or cancel, notify us at least 24 hours in advance to avoid a standard $50 short-notice fee. Exceptions are made for sudden medical emergencies.

ⓘ  Payment Policy

Ballantyne Plastic Surgery does not accept insurance. Payment is due at the time of service; we accept check, all major credit cards, and approved patient financing through CareCredit, PatientFi, and Cherry. Unpaid balances may incur billing fees.

ⓘ  Late Arrival Policy

If you are running late, please contact our front desk immediately. Appointments delayed by 15 minutes or more may need to be rescheduled or compressed to preserve the schedule integrity for subsequent patients.

ⓘ  Privacy & HIPAA Compliance

Your private medical information is safeguarded in strict accordance with federal law. Personal records, diagnostic scans, and clinical histories are completely encrypted and never shared without active consent.
Step 4: Connect With Us

Have Questions? We are Here to Help

Reach our administrative coordinators via phone, email, secure medical fax, or visit our central clinic location.

Contact Information & Hours

  • 14135 Ballantyne Corporate Pl #150, Charlotte, NC 28277
  • manager@ballantyne-plastic-surgery.com
  • (704) 769-3107
  • Fax: 704-295-0774
Operating Hours
Monday – Thursday
8:00 AM – 5:00 PM
Ballantyne Plastic Surgery

14135 Ballantyne Corporate Pl

#150, Charlotte, NC 28277
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