appointment by filling them out in advance and bringing them with you.
If you have any questions, call us and we will assist you.
Our Cary and Raleigh offices can be reached at 919-443-2557.
Our Greensboro office can be reached at 336-443-9300.
New Patient Forms
New patient appointments usually take 30-45 minutes, depending on your specific condition. For your convenience, we have attached our new patient packet below. All forms in the packet below can be completed on our Patient Portal with the exception of our New Patient Information form. If possible, we ask that you sign up for a portal account and sign our policies on the portal, but if you are unable to do so please print the new patient packet below and bring a completed copy to your appointment.
The New Patient Information form can be printed from the portal or from the link below.
By filling out the new patient packet ahead of time, you will save significant time at the beginning of your visit. If you have any questions about accessing the patient portal or filling out the new patient packet, our team will be happy to assist you. After your appointment, there may be additional forms to fill out and sign as well.
What to Bring to Your Appointment
- Completed forms
- Insurance cards
- Driver’s license
We participate with most major insurance plans. If we participate with your insurance, applicable consultation fees will be billed to your insurance and you will be expected to pay deductibles, co-insurances, copays, and any non-covered services. You will be expected to pay any copays at the time of service. For cosmetic or self-pay patients, payment for the initial consultation is expected in full at the time of the visit. We accept cash, checks, Discover, MasterCard, and Visa. We look forward to meeting and assisting you with your oculofacial plastic care!
Physician Referral Forms
For doctors’ offices requesting a consultation, please download and complete the Referral Form and fax it back to us at 919-869-1869.
For the convenience of their patients, Dr. Renzo Zaldívar is accepting new patients in our Cary, Raleigh, and Greensboro locations.
**Please note, at this time, patient forms cannot be submitted through this website. Patient’s please PRINT these forms and bring them with you to your appointment**