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PATIENT RESOURCES

Office Information

Office Hours

Our office at 515 South Drive, Suite 25, Mountain View, CA 94040 is available for consultations from 9:00 am – 5:00 pm, Monday through Friday.

Contact Information

To schedule an appointment, please call us today at 650.964.2200. To fax our office, dial 650.964.2205.

After Hours (Emergency Only): Dial 911 or go immediately to the nearest emergency room. For urgent calls, contact Dr. Fazilat directly at 650.964.2200.

Parking is available on South Drive. Click here to view a map.

Patient Forms & Instructions

At Dr. Fazilat’s office, we want to make your experience with us as convenient and efficient as possible. To save time during your initial appointment, please download and print the following forms, complete them at your convenience, and bring them with you.

If you choose not to fill the forms out before your appointment, please arrive 20 minutes early to complete the forms.

Patient Information Packet
New Patient Information, Page 1 (PDF)
Medical Information Form, Page 2 (PDF)
Notice of Privacy Practices, Page 3 (PDF)

Please refer to these helpful instructions prior to your particular procedure:
Laser Hair Removal Instructions
Consent Form, Elite MPX Laser Hair Removal (PDF)
Consent Form, Elite MPX IPL Laser Hair Removal (PDF)
IPL Post Treatment Recommendations (PDF)
Post Treatment Skin Care Instructions (PDF)

Pre- & Post-Operative Instructions
Laser Pre-Treatment Skin Care Instructions (PDF)
Abdominoplasty Post-Op Instructions (PDF)
Blepharoplasty Post-Op Instructions (PDF)
Breast Augmentation Post-Op Instructions (PDF)
Facelift Post-Op Instructions (PDF)
Labiaplasty Post-Op Instructions (PDF)
Liposuction Post-Op Instructions (PDF)
Thighplasty Post-Op Instructions (PDF)

Need Adobe Acrobat Reader?

If you do not have a copy of Acrobat Reader, you can get one for free by clicking on the icon “Get Acrobat® Reader” logo to the right. This will take you to Adobe’s website and enable you to download the Acrobat program to your computer.

Payment Information

Dr. Shahin Fazilat’s office accepts payment via cash, check, all major credit cards and Care Credit. At the time the service is provided in our office, we request payment for consultations, treatments for injectables, plus any advanced skin care procedure and products. Our staff will be happy to answer any questions concerning fees, payments due or payment options.

Payment for cosmetic surgery procedures will be discussed during your consultation visit. A $500.00 deposit is required to secure a surgical date. The balance of your fees is due two weeks prior to your surgery. Cash, a personal check or credit card payment will be accepted for your balance.

There will be a $35.00 fee for any checks returned for non-sufficient funds. A $15.00 fee will be collected for Medical Record copies, FMLA, Disability, and other Third Party forms needing attention by our staff.

Cancellation Fee

If you should need to re-schedule or cancel your appointment, we ask that you contact our office at least 24 hours in advance. There is a $100 fee for a cosmetic consultation that is non-refundable if your appointment is cancelled with less than 24 hours notice. If you should need to re-schedule or cancel your surgery also call as early as possible. Should you cancel your surgery within 14 days of your scheduled surgery date you will be subject to forfeiture of your surgery fee. This fee can be applied to a future surgery date. Should you cancel more than two weeks in advance you will be subject to forfeiture of your $500 deposit.

Insurance/Billing/Financing Options

Dr. Fazilat’s office is an out-of-network provider with most insurance plans, but will work with your insurance company to submit medically necessary claims for processing. Prior to surgery, we will verify the coverage provided by your health insurance plan; however, our patients are responsible for the co-pay, deductible, and co-insurance, as well as what may not be covered by your insurance.

For specific questions related to your insurance please email scheduling@fazilatmd.com and our Billing Department will answer your questions.

Financing is available through Care Credit and Alphaeon. Please feel free to contact us at 650.964.2200 regarding other plastic surgery financing plans that may be available.

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