Privacy Forms

Patient Forms

For your convenience, you can now complete all Renaissance patient forms through our secure online Patient Portal.

Take advantage of the online services offered by our practice with the assurance that all of your information is encrypted and stored securely.

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After you create your account, you will receive an e-mail from us that includes your user ID and a link back to our patient portal. You may log in at any time to begin using our services.

Our most common patient forms are also available for download by visiting the links below. If you choose to not use the Patient Portal you may download, print, and complete these forms prior to your visit. Then bring them with you for your visit or return them earlier (by mail or fax) to expedite your visit.

All Forms:

New Patient Packet Forms

Individual Forms:

Renaissance Surgical Centre Patients Rights and Responsibilities
Medication List
HIPAA Notice of Privacy Practices

Renaissance Rewards

VIP Program

Our new VIP Program, Renaissance Rewards, is now open and ready for enrollment!  Get the best prices on all your aesthetic treatments like Botox, fillers, microneedling, and more all year long.

Earn an additional 10 FREE Units of Botox when you sign-up for Renaissance Rewards in December 2022! That's another $120 in rewards on top of your annual savings!

 

Offer ends 12/29/22

Renaissance Rewards VIP Program