Plastic Surgery | Mansfield | Cedar Hill Office Policies & Patient Forms Plastic Surgeon Mansfield | Dr. Richard Jerry Burkett, MD | Cedar Hill Breast Augmentation | Breast Reduction | Mansfield | Cedar Hill Breast Implants | Breast Lift | Liposuction | Mansfield | Cedar Hill Dr. Richard Jerry Burkett, M.D. | 1770 E. Broad St. | Suite 100 |  Mansfield, TX 76063 | (817) 473-6969 Breast Augmentation | Breast Reduction | Mansfield | Cedar Hill Cosmetic Surgery Mansfield | 1770 E. Broad St. | Suite 100 |  Mansfield, TX 76063 | (817) 473-6969
Office Policies & Patient Forms Plastic Surgery | Mansfield | Cedar Hill
     
 

Plastic Surgeon Mansfield - Dr. Richard Burkett is a plastic surgeon with a state of the art office serving Mansfield, Cedar Hill, and the surrounding areas.  Call today to schedule an appointment or consultation: (817) 473-6969Appointments & Consultations

To schedule an appointment please call:
(817)473-6969. The following forms can be downloaded to your computer and printed at home.

       
  Patient Information Form   Health Information Form
           
  Patient Informed Consent Form   Breast Information Form
           
     


Cancellation Policy

If you are unable to keep an appointment, we ask that you kindly provide us with at least 48 hours notice. This courtesy, on your part, will make it possible to give your appointment to another patient.


Emergencies

Our office provides on-call service for emergencies 24 hours a day, 7 days a week.  After hours call 972-780-4415 and Dr. Burkett will be contacted immediately.


Insurance

Our office participates with most health insurance plans which cover certain reconstructive plastic surgery procedures. Covered procedures will vary with each insurance company.  Our office staff will assist you in determining eligibility.  Please contact our office or your health care company to confirm that Dr. Burkett is a participating provider with your insurance group.  Patients are responsible for deductibles, co-payments and remaining balances at the time of service.

Our office accepts workers compensation.  Dr. Burkett is on the Texas Workers Compensation Commission ADL list.  Please have your employer contact our office to provide billing information.

  Worker's Compensation Form

As a courtesy, we will bill your insurance directly for any surgery that is covered by insurance.  Please have your insurance information available for your visit.  If you are a member of an HMO health care plan please be sure the appropriate referrals have been sent by your Primary Care Physician.  We cannot see managed care patients unless there is a valid referral on file. 

Most medical insurance plans will not cover cosmetic procedures.  The exact cost of a specific procedure or combination procedures will be quoted by Dr. Burkett at the time of your consultation.  Estimated prices are also available by phone.  There may be added charges for any required pre-operative testing, or for any required pathological diagnosis (tissue examination).  As is customary, fees for cosmetic surgery are to be paid in full at the time surgery is scheduled.


Financing

Our office will be able to assist you with a financing program for elective procedures.  Patients may be pre-approved for financing with a low interest monthly payment plan.  Our office manager would be pleased to provide you with further details.

Patient financing if available through: CareCredit.com & ChaseHealthAdvance.com   


Billing and Payment

Co-payments, co-insurance and deductibles are due at time of visit.  We accept credit card (MasterCard and Visa), cash, check, money order or cashiers checks.

   

 

           
 
     
     
   
   
   
   
   
   
   
   
   
 

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Cosmetic & Plastic Surgery, Dr Richard Burkett, M.D., Surgeon serving Mansfield, Cedar Hill, Arlington, Haltom City, Cleburne, Granbury, Midlothian, Ennis,
Duncanville, DeSoto, Burleson, Azle, Haslet, Trophy Club, Waxahachie, Red Oak, Weatherford,
Grapevine, Southlake, Bedford, Hurst, Highland Park and the surrounding area.

Richard Burkett, M.D., | 1770 E. Broad St. | Suite 100 | Mansfield, TX 76063 | (817) 473-6969

Copyright © 2006 Richard J. Burkett, MD. All Rights Reserved.