Patient Forms & Financing
Accommodations Near Our Center
The Rose Clinic migraine and plastic surgery center serving Provo and Salt Lake City, Utah, is located in beautiful Utah Valley – home to BYU and UVU, and just minutes away from the spectacular Provo Canyon and Robert Redford’s Sundance Resort.
For information about local accommodations, click here.
Financing Your Plastic Surgery in Utah
At The Rose Clinic, we don’t want financial concerns to come between you and looking and feeling your best. For your convenience, we accept most major credit cards, and offer financing through CareCredit to accommodate a variety of financing needs and credit profiles.
We’re pleased to offer our patients the CareCredit card, North America’s leading patient payment program. The CareCredit card is just as easy to use as a regular credit card, but it’s designed specifically for your health and beauty needs. Best of all, CareCredit offers convenient payment plans and no hidden costs. You can even use your CareCredit card over and over for follow-up appointments.
Click here to apply online with CareCredit.
Calculate your low monthly payment.
If you would like to get some of your paperwork taken care of before your office visit, please use the patient forms below.
- Patient Fact Sheet
- Medical History
- Photo Release
- Arbitration Agreement
- Insurance Information
- Migraine Questionnaire
- Functional Nose Information Sheet
- Migraine Calendar
- Post Injection Migraine Questionnaire
- Drugs to Avoid
For more information about our Utah plastic surgery and migraine treatment options, click here to contact us online. Or you can call The Rose Clinic at 801-375-ROSE (7673) and one of our helpful staff members will schedule your appointment.