CONTACT US TODAY FOR
YOUR CONSULTATION
CONTACT US TODAY FOR
YOUR CONSULTATION
Home » Patient Forms

Patient Forms

You may print and fax the following patient forms for Fayetteville Plastic Surgery & Cape Fear Aesthetics to 910-222-3068.

 

FPS New Client Intake
Reservation & Cancellation Policy (effective 8-1-2017)
Dr. Edward Dickerson Referral Form
Medical Intake Form
Medicare_Medicaid Supplemental Form
HCG Weight Loss Intake & Consent
Media Release Consent
Fillers Consent
Botox/Xeomin Consent
Laser Hair Removal Consent

 

NOTE: PDF files require Adobe Acrobat Reader to view. If you do not have Acrobat Reader, you can download a free copy here.

PATIENT TESTIMONIALS

“The staff is amazing. I just love this place.” -Robin Barnes

PATIENT TESTIMONIALS

“It’s like night and day from where I was before. I am no longer on my way to becoming a diabetic.” -James Pilgrim

PATIENT TESTIMONIALS

“I love Dr. Dickerson and his staff. They are so comforting, warm, welcoming… they make you feel at home.” -Tamu Brown

PATIENT TESTIMONIALS

“As soon as I came in I automatically felt at ease. Everyone is warm and courteous.” – Dinah Goodman

Plastic Surgery in Fayetteville, NC