Contact Us

Absolute best plastic surgeon in the valley. He is so kind and good at his work, I am more than happy with my results.

GABRIELA • PEORIA, AZ

We Look Forward to Hearing From You!

(602) 610-9111

Address 18555 N 79th Ave, Bldg B, Suite 102, Glendale, AZ 85308

Email Info@drbradleybecker.com

Our Contacts

Open Hours

Monday 9:00 AM - 5:00 PM

Tuesday 9:00 AM - 5:00 PM

Wednesday 9:00 AM - 5:00 PM

Thursday 9:00 AM - 5:00 PM

Friday 9:00 AM - 5:00 PM

Sat/Sun Closed

Contact Us

Absolute best plastic surgeon in the valley. He is so kind and good at his work, I am more than happy with my results.

We Look Forward to Hearing From You!

(602) 610-9111

Our Contacts

Open Hours

BRADLEY K. BECKER, D.O., P.L.L.C.

SURGERY DEPOSIT

Cancellation and Rescheduling Policy:

Cancellation and Rescheduling Policy:

There will be no funds held back in the event of rescheduling or cancellation by us, or in the event of a documentable medical reason with a treating doctor’s statement once reviewed and approved by Dr. Becker.

BRADLEY K. BECKER, D.O., P.L.L.C.

PATIENT RESPONSIBILITY FORM

1. INDIVIDUAL'S FINANCIAL RESPONSIBILITY

2. INSURANCE AUTHORIZATION FOR ASSIGNMENT OF BENEFITS

3. AUTHORIZATION TO RELEASE RECORDS

4. MEDICARE REQUEST FOR PAYMENT

BRADLEY K. BECKER, D.O., P.L.L.C.

IMPLANT REMOVAL AND DISPOSAL FORM

BRADLEY K. BECKER, D.O., P.L.L.C.

MEDICAL HISTORY FORM

BREAST:

MOHS:

FAMILY HISTORY:

SOCIAL HISTORY:

BRADLEY K. BECKER, D.O., P.L.L.C.

PATIENT INFORMATION

GUARANTOR INFORMATION

INSURANCE INFORMATION

BRADLEY K. BECKER, D.O., P.L.L.C.

PHOTOGRAPHY CONSENT

PHOTOGRAPHY CONSENT

RELEASE OF PHOTOGRAPHS CONSENT

BRADLEY K. BECKER, D.O., P.L.L.C.

Notice of Privacy Practices: Use of Disclosure of Health Information Protected under HIPAA

Patient acknowledgement: