Patient Info and Forms

New Patient Info

During your first appointment with us, we will begin with a consultation with Dr. Ghaznavi to review your treatment goals. Dr. Ghaznavi will perform a detailed examination of the area you would like to address and provide you with your treatment options, what to expect from treatment and estimated costs. If you have any questions, you can call us at (703) 239-3190, fax us at 571-621-7593, or request an appointment online.

New Patient Forms

For your convenience, our new patient forms can be completed online. To save time during check-in, simply click the buttons for the forms below, and complete them prior to your appointment with us.

Financial Policy and Procedures

01. Consultation Fee for In-Office or Virtual Visit

• A $150 non-refundable consultation fee is required.
• A valid credit card is required to book, and the fee is collected at the time of scheduling.
• We do not accept in-office payments for the consultation fee.
• No surcharge applies to the consultation fee.
• The consultation fee is applied toward the final procedure fee only when a surgical deposit is collected within 30 days of the consultation.

02. Consultation Reschedule, Late Arrivals, and No-Shows

• The consultation fee is non-refundable.
• One reschedule is permitted if requested more than 48 hours before the appointment, or when an exemption applies.
• Reschedule requests received fewer than 48 hours before the appointment are treated as a no-show. The consultation fee is forfeited, and a new $150 consultation fee is required to rebook.
• No-show or arriving more than 10 minutes late without notice results in forfeiture of the consultation fee. A new $150 consultation fee is required to reschedule.
• One grace waiver is available per patient.
• Exemptions include medical emergencies, severe weather, and practice-initiated changes.

03. Payment and Authorization

• We accept credit card payments by phone or online, in-person cashier, e-checks, cash, or financing through approved partners.
• Policy-based fees are automatically charged to the card on file when applicable.
• The full balance for surgery, including the surgeon’s professional fee, must be paid in full no later than 30 days before the scheduled surgery date. Failure to meet the payment deadline may require postponement of surgery.

04. Surgical Deposits and Refunds

• Payment deadline: the full balance for surgery must be paid no later than 30 days before the scheduled surgery date. If surgery is scheduled fewer than 30 days out, the full balance is due at booking.
• Deposit required to schedule: a surgical deposit is required to reserve a surgery date. No surgery date is confirmed until the deposit is received.
• Cancellation notice: all cancellations must be submitted in writing by email or through the patient portal. The effective cancellation date is the date and time we receive written notice.
• Refunds: if written cancellation notice is received 30 days or more before the scheduled surgery date, all surgery payments received, including the surgical deposit and the surgeon’s professional fee, will be refunded to the original form of payment, less any non-refundable charges already incurred under other practice policies.
• If written cancellation notice is received fewer than 30 days before the scheduled surgery date, the surgical deposit and the surgeon’s professional fee are non-refundable and will be retained by the practice.
• Approved refunds are issued to the original form of payment. Processing time depends on the payment method and financial institution.

05. Surgical Rescheduling Policy

• Patients are permitted one courtesy reschedule of their surgery date, subject to scheduling availability and the timing of the request. Rescheduling fewer than 30 days before surgery counts as the courtesy reschedule.
• Requests received 30 days or more before surgery: the first reschedule is free of charge. A second reschedule is permitted with a $750 non-refundable rescheduling fee. All payments remain on the patient’s account and apply to the rescheduled date.
• Requests received fewer than 30 days before surgery: rescheduling is permitted only with practice approval and may require a $750 non-refundable rescheduling fee due to staffing, facility, and scheduling commitments. All payments remain on the patient’s account and apply to the rescheduled date.
• Cancellation after a reschedule: if the surgery is canceled fewer than 30 days before the scheduled surgery date, the surgical deposit and the surgeon’s professional fee are non-refundable. This rule applies even if the original surgery date was more than 30 days away.
• If AMG Plastic Surgery or the surgeon initiates the reschedule for any reason, no rescheduling fee is charged, and all payments apply to the rescheduled date.

06. How to Cancel or Reschedule

• Call (703) 239-3190 or message us through Klara during business hours, Monday through Friday, 9:00 AM to 5:00 PM.
• We do not accept cancellations through text message, social media, or voicemail.
• Appointment reminders by text and email are provided as a courtesy.

07. Cosmetic Surgery Quote Details

• Quotes are valid for 30 days from the date signed. After 30 days, pricing may be reviewed and adjusted.
• Quotes typically include the surgeon’s professional fee, facility fee, anesthesia services, pre-op and post-op visits, and required medical equipment when applicable.
• Quotes do not include prescription medications, lab testing, or medical clearance charges unless stated in writing.
• Quotes show the base price and the credit card total with the 3% surcharge.

08. Surgical Clearance and Required Testing

• Patients are responsible for charges related to surgical clearance, including lab work, EKGs, imaging, medical clearances, prescriptions, and pathology when applicable.

09. Revisions, Complications, and Refunds

• Surgery involves risk, and results vary. Outcomes are not guaranteed.
• If complications occur, additional treatment or procedures may result in additional charges unless otherwise agreed in writing.
• Revision procedures may require additional facility and anesthesia fees.
• Refunds are not issued based only on dissatisfaction with cosmetic outcome when the procedure met the standard of care.
• Fees for revisions within 12 months are set at the surgeon’s discretion.

10. Insurance Policy

• We accept a limited number of insurance plans for medically necessary reconstructive procedures.
• Cosmetic procedures are not covered and will not be billed to insurance.
• We file insurance claims as a courtesy. Patients remain responsible for all balances.
• If insurance denies a service as not medically necessary, patients may request an out-of-pocket estimate.
• No credit card surcharge applies to any insurance payment. This includes co-pays, coinsurance, deductibles, and any service billed to insurance, in network or out of network. Cosmetic surgery not billed to insurance follows section 12, even for patients with insurance on file.

11. Payment Methods and Financing Options

• We accept cash, Visa, Mastercard, Discover, and American Express.
• Personal checks must be received no later than 30 days before surgery. Returned checks incur a $50 fee.
• Financing options are available through approved partners, including CareCredit, Cherry, and Northwest Federal Credit Union.
• Cherry offers terms from 3 to 60 months with 0% APR available for qualifying applicants.
• Financing is subject to approval. Financing should be completed before final payment deadlines.

12. Credit Card Surcharge on Surgical Payments

• Starting November 9, 2026, a 3% surcharge applies to surgical deposits and surgical payments made by credit card. The surcharge never exceeds our cost of card acceptance.
• No surcharge applies to debit cards, HSA or FSA cards, prepaid cards, bank transfers, e-checks, cash, personal checks, or approved financing.
• No surcharge applies to the consultation fee or to any insurance payment.
• The surcharge amount is shown before you pay, and you accept or decline before the charge goes through. The surcharge appears as a separate line on your receipt.
• When a surgical payment is refunded in full or in part, the matching share of the surcharge is refunded with the payment.
• Patients who live in Connecticut, Massachusetts, or Maine are not charged the surcharge. These patients pay surgical balances by phone or in person with our front desk.

13. Garments and Medical Supplies

• All sales of compression garments and medical supplies are final. These items are non-refundable and non-returnable once dispensed.

Version 11.01.2026

Online Bill Pay

Insurance

In Network

• Medicare- Part B and Part D
• United

Out Of Network

• Aetna – PPO, EPO, HMO, Medicare HMO and Medicare PPO
• Anthem Blue Cross Blue Shield
• Cigna – Open access plus, open access local plus, PPO and HMO
• Carefirst- Bluechoice, Regional PPO and PPO
• Tricare East Region
• Tricare For Life

Do Not Accept

• Medicaid
• Humana
• Aetna Innovation/INOVA Health
• Anthem HealthKeepers
• Magellan of Virginia
• Cigna EPO

We are proud to offer our patients financing through CareCredit, Cherry and Northwest Federal Credit Union. We believe that everybody deserves to feel their best, and we strive to make paying for your treatment and procedures with us as convenient as possible. Please read more about our financing options below, and call or text (703) 239-3190 if you have any questions!

Financing Options

CareCredit

AMG Plastic Surgery is proud to accept healthcare financing with CareCredit. CareCredit offers financing plans as convenient as 24 months with no interest, to help you pay for your health, wellness and personal care needs.

Learn More And Apply Today

Cherry Financing

AMG Plastic Surgery is pleased to offer Cherry Financing, providing patients with a convenient option for managing the expenses of cosmetic treatments. Through Cherry, patients have the opportunity to divide costs of cosmetic procedures, up to $30,000, into monthly payments that are easy to handle. The payment plans are flexible, ranging from 3 to 60 months, to accommodate various financial situations. Additionally, patients can benefit from 0% APR* options, making aesthetic enhancements accessible and affordable for everyone. For example, a $400 payment plan with Cherry may cost $100/month over 3 months at 0% APR with down payment in the amount of monthly payment due at the time of purchase.

*0% APR and other promotional rates subject to eligibility

Northwest Federal Credit Union

AMG Plastic Surgery is pleased to partner with Northwest Federal Credit Union to provide additional financing options for your cosmetic procedures. Member financing options may be available through Northwest Federal Credit Union. For more information about available payment plans and eligibility, contact Northwest Federal Credit Union directly or ask our financial coordinator at (703) 239-3190.

Patient Resources

At AMG Plastic Surgery in Herndon, VA, we aim to thoroughly educate our patients so they can make the best and most informed decisions about their care. To help make your treatment journey go smoothly and seamlessly, we have provided patient resources including information about your recovery, videos and more. If you have any questions, please call us at (703) 239-3190 or fill out the contact us form on our website.

• Prepare for a smooth recovery after plastic surgery
• Can you speed up your recovery after plastic surgery?
• Breast implant safety
• Preparing for plastic surgery
• Cosmetic surgery: What to know beforehand
• Tummy Tuck Recovery: Timeline, Tips, and More
• Your facelift recovery explained from Day 1 to Day 30
• Nine tips from a plastic surgeon and patient for a smoother recovery