Chesterfield, MO
(636) 530-6161
Please fill out our New Patient Form below and provide as much information as possible. If we have any further questions you will be contacted accordingly.
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Telehealth Authorization and Release
Dr. LundDr. NathanDr. PradaDr. Sarhaddi and his/her staff and personnel (hereinafter referred to collectively as “my Doctor”) so as to conduct virtual consultations, telemedicine/telehealth, and any other purpose deemed by my Doctor to be appropriate while I am receiving medical and aesthetic services.
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Payment Policy
Because our services are rendered to YOU, you are responsible directly to us for settlement of your account within the time limit set. Please feel free to discuss your bill or charges at an early date, to avoid misunderstandings.
It is understood that failure to comply with this agreement would leave St. Louis Cosmetic Surgery, Inc. no alternative but to seek collection action.
The quote that you receive at your consult will include the doctor’s fee, plus OR and anesthesia. Payment of these fees will be due prior to surgery.
Due to the HIPAA (Health Insurance Portability and Accountability Act) all information must be completed on this form and the following forms. If you have any questions regarding this, anyone in our office will be glad to help you.
Thank you for choosing St. Louis Cosmetic Surgery
We have reopened! Please review our safety protocols before coming to the practice.
We are offering virtual consultations. Please contact the office to schedule your consultation today.