Dr. Lucie Capek

Plastic Surgery

Capital Region Health Park

713 Troy-Schenectady Road. Suite 308 | Latham, NY 12110 | Phone: 518-786-1700 | Fax: 518-786-9241

Pre-Registration Forms

Please see below for commonly used office forms. To reduce your waiting time in the office, you may download and fill them out prior to your initial consultation with Dr. Capek.

 

Patient Information Form Adobe Acrobat File
Medical History Form Adobe Acrobat File
Assignment of Benefits Form Adobe Acrobat File

 

CareCredit

 

medfin2

Designed for Dr. Lucie Capek by the American Society of Plastic Surgeons

Capital Region Health Park, 713 Troy-Schenectady Road, Suite 308, Latham, New York, 12110