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Facelift Patient Registration

We recommend that you use our secure on-line registration form in order to quickly register you in our scheduling system prior to your appointment for a facelift consultation with Dr. Summers at the Maryland Plastic Surgery Center.  All information entered on this form is protected by 128-bit SSL and stored only on a HIPAA secure server – the information is not visible across the Internet.  Although we recommend that you complete all sections on the Facelift Patient Registration Form, you may elect to enter only the required fields.

NEW PATIENT REGISTRATION FORM

When you click the link above to open a new facelift Patient Registration Form, your browser will open a new window that is protected with a security certificate.  When you are done entering all of the necessary information, simply close the registration window and continue browsing this site.

After you submit your registration form, contact us using the Request An Apppointment form or by calling our office to schedule your appointment.  Please let us know that you have completed the Secure On-line New Patient Registration Form so we can verify your information on our system.

If you have any questions, we encourage you to send us an e-mail using our Contact Form.

On-line registration is not a requirement.  You may call our office and we will enter preliminary information over the phone – the remaining information may be completed on our paper forms in the office.