Enrollment Instructions

Instructions for Surgeons: The following items are required for enrollment.

1. Completed and Signed Enrollment Application Form
2. In addition, the following items should be faxed or mailed to us.
   ♦  Copy of Your Current Curriculum Vitae
   ♦  Signed Confidentiality Agreement
   ♦  Signed Disclaimer Agreement
   ♦  Copy of liability insurance policy (malpractice coverage)
   ♦  1 letter of recommendation (from a physician colleague providing specific information about your professional ethics
        and surgical skills.)
   
3. $1,800 Deposit: Due with application. This may be paid either by credit card via telephone (949-248-1632) or by
   sending a check payable to Jeffrey Klein, M.D.:
   
   Liposuction 101
   30280 Rancho Viejo Road
   San Juan Capistrano CA 92675.
   
   $5,000 Balance is due 6 weeks prior to the first day of the course.
   
4. Recommended Text Book: Tumescent Technique, by Jeffrey Klein, Mosby, 2000, should be read before arriving in San
   Juan Capistrano for the course (This book is currently sold-out; please ask us for an electronic copy of the text).
   

  Enrollment Application Form (Printable)

  Confidentiality Agreement (Printable)

  Nurse & Medical Assistant Application Form (Printable)

  Disclaimer Agreement (Printable)