Dr. Rucker Joseph Rucker, MD, FACS. Member American Society of Plastic Surgeons

Patient Information & Financing

Patient Information


New patients or those patients being seen for a new condition, will be asked to complete a medical history form upon their arrival for a scheduled appointment. This form is available here for those that would like to review and complete this form prior to arrival at the clinic.


Click on the following forms to download a PDF* version.

Patient Information
To be completed by all patients before their first visit.

Health Questionnaire
To be completed by all patients before their first visit.

Patient Interest
To be completed by all patients before their first visit.

*PDF files can be opened and printed with Adobe Acrobat Reader (with a PC or a Mac), which is a free program that can be downloaded from Adobe



Patient Financing

We accept:
  • VISA
  • Mastercard
  • Discovercard
  • American Express



  • Other financing options:


    Cosmeti Credit
    Patients can apply on-line, directly with this company,
    from the privacy of their own home. 

    This plan may be used for:

    • Balance due after insurance has made payment
    • Patients with no insurance
    • Cosmetic surgery
    • Medispa packages

    "My general surgeon saved my life, but you gave it back to me by making me feel whole and normal again..."
    ~CS

    More Testimonials

    You can reach me at 800.456.8222 or 715.833.2116 orsend me an email.

    I'd be happy to answer any questions you may have or schedule an appointment for you.

    Patient Information and Financing (downloadable forms)

    Replica Rolex