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Patient Forms

New patients will need to fill out patient information, patient history and insurance forms. We have included these standard forms below. Please print and fill out each form prior to coming in. You will need Adobe® Acrobat® Reader™ -- a plugin is available from Adobe.



Patient Financing

As you consider cosmetic surgery you may be wondering about your payment options. There are a number of payment options. We offer an array of programs designed to meet your individual needs.

For financial assistance, call Jenny at (888) 455-FACE  or email her at,   Jenny has worked with Premier Image Cosmetic & Laser Surgery for over 10 years.  She's helped many patients achieve their dreams with payment plans that fit comfortably in their budgets.

Types of Payments

  • Cash or Check: Personal check, cashier's check, or cash.
  • Credit Cards: Visa, MasterCard, Diner's Club, Discover, or American Express.


Patient Payment Plans:

We offer a number of patient financing options.  Call and speak with our financial counselor, Jenny.  You want to be sure you are applying to the company that will best meet your individual needs.  Jenny can guide you in choosing the best options and help you with the pre-screening process that will not affect your credit.

We offer No Interest (same as cash) payment plans for up to 12 months. We also offer extended payment plans for 24, 36, 48 or 60 months with varying rates of interest depending upon your credit history.

CareCredit plastic surgery financing

CareCredit gives you the freedom to get your plastic surgery procedure whenever you’re ready. It’s easy to apply. With three simple steps, including an instant approval process, you can say goodbye to the waiting time and reward yourself sooner. CareCredit offers interest-free loan options starting as low as $300 for 3, 6, or 12 months to qualified applicants. They have payment plans available for 24, 36, 48 and 60 months.  They offer up to $25,000 in financing.  * From above: Based on qualifying Care Credit loan for $5000 - 60 month payment plan at 11.9%. Apply on line:

Plastic surgery financing

Capital One makes it easy to afford the reconstructive or cosmetic surgery that you need or want. Use Capital One® Healthcare Financesm to pay for procedures, from $750 to $25,000.  Capital One offers installment loans with low, fixed rates from 1.99% APR to 25.99% APR*, or interest-free loans** for 3, 6, 12, 18, or 24 months to qualified applicants. Either way, you'll be able to find an option designed to fit within your budget.   You'll like their flexible payment options—we can set up a payment schedule for you, from 18 months to five years.  Capital One Healthcare Finance helps make high quality cosmetic procedures—and your new look— a reality.   Apply online

Unicorn patient financing

Reliance offers the most affordable and flexible credit terms in the industry. You can choose from a wide variety of payment options and programs to best fit your budget and specific financial needs. These choices make Reliance the ideal financing source for any medical procedure.  Among the lowest on the market, our rates begin at 6.9%. They also offer interest free plans for the first 3, 6, or 12 months, as well as extended plans from 12-60 months with no money down and no pre-payment penalties! Your rate will be based on your credit score and any offer you receive from Reliance is good for 30 days.* Apply online.


Chase Healthcare Financing is the easy, fast and flexible way for you to cover the costs of the medical treatments and procedures you want by allowing you to finance elective procedures from $500 to $25,000. We offer convenient payment options designed to fit within your budget. Choose from either No Interest terms of 3, 6,12 or 18 months* or extended term low interest equal payment plans of 24, 36, 48 or 60 months*. Use our on-line calculator to see just how low your monthly payment could be!  Apply online.




Patient Links

Click here for Cosmetic Dentistry




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Dr. William Silver, MD, Dr. Louis DeJoseph, MD, and Dr. Marc Klein, MD, serving Atlanta and the surrounding area.

Premier Image Cosmetic & Laser Surgery: 4553 North Shallowford Road - Suite 20-B - Atlanta, GA 30338-6408 - Tel: (770) 457-6303 - Toll Free: (888) 455-FACE

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