At the Polacek Center for Plastic Surgery in Rhode Island, your experience is of the utmost importance to us. We want each of our patients to feel relaxed, assured, and confident throughout their journey. We strive to make things as efficient and uncomplicated as possible, so that you can focus on the more exciting aspects of your procedure. The following resources are provided to help you to plan for your surgery.
- For those who are interested, we offer fees & financing information to help you explore your payment options.
- Need help finding us? Get directions to our office in Cranston.
Patient Forms
For our new patients, we have made all of our necessary forms available online so that you can fill them out at your leisure and bring them with you to your first appointment. Please be sure to complete every form listed below:
- What are your Concerns Today? – Aesthetic Questionnaire 1
- What are your Concerns Today? – Aesthetic Questionnaire 2
- Patient Information Form
- Credit Card Policy Form
- Cancellation / No Show Policy Form
If you haven’t already done so, request a consultation at the Polacek Center for Plastic Surgery. Or phone us at (401) 331-0202 and we will discuss the best approach to address your specific needs.
Preparing for Your Appointment
- Important updated information regarding our protocols for the COVID-19 vaccines and other vaccinations: In the past year we have recommended avoiding vaccinations (ie. Flu, shingles, pneumonia) for the two weeks prior and 2 weeks after having dermal filler injections. These recommendations are still in effect. We have now added additional instructions for patients receiving the COVID vaccine. We recommend waiting for 2 weeks to receive the vaccine if you have recently had dermal filler.
If you have received the Pfizer vaccine, we recommend waiting for 8 weeks after the 1st dose to have filler. If the Moderna vaccine was received, the recommended wait time is 10 weeks from the initial vaccine to have filler. If you’ve received the Johnson and Johnson vaccine, please wait one month to have filler.
With BOTOX and skin care treatments we recommend treatment 2 days before or after the COVID vaccine. Any questions please contact our office as far in advance as possible prior to your appointment with us.
- Please arrive at our office with a clean face (if possible) prior to scheduling an appointment for fillers or please plan to remove makeup with us in our restroom upon arrival if you are coming from an event, work etc.
- Please download the Brilliant Distinctions® app or visit brilliantdistinctions.com online to reset your personal password so that you will receive points towards treatments and products with Allergan® at each visit.
- Please fill out paperwork online prior to your appointment (especially new patients or patients that have not updated our paperwork in the past year).
- Please plan to have no dental appointments (including cleanings) 2 weeks prior and 2 weeks after filler.
- Please let us know about medical conditions, planned surgeries, change in weight since the last appointment, or infections that you might have at the time of the appointment prior to your visit so that we can guide you as to whether or not you can be treated at that appointment prior to injecting.
Cancellation Policy
If you need to cancel your appointment, please call our office at least 48 hours before your scheduled date; we do not accept cancellations via text message in our reminder portal. To cancel a Monday appointment, please call our office during business hours by Thursday of the week prior. Please note: if you do not cancel your appointment with 48 hours’ notice, there is a cancellation fee of $100 (for Dr. Lori G. Polacek) or $50 (for Beth Walker, our medical aesthetician, and Crystal Esquilin, our CoolSculpting® specialist).