Patient Form

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Patient Form 2017-07-19T14:58:49+00:00

New Patient Forms

In order to make a first visit seamless, we recommend that new patients complete the forms below prior to their first appointment and then deliver the forms to the reception desk on the day of the first appointment. Arriving to your scheduled appointment with your prepared forms will significantly decrease your time in the waiting room.

We also ask that you bring with you a photo ID and insurance card. We do not accept insurance, and payment is accepted at the time of service. However, as a courtesy to you, we will submit your bill to your insurance company for reimbursement to you at an out-of-network rate.

Thank you for scheduling your appointment at the Santa Monica Laser and Skin Care Center. We look forward to meeting you soon!

Please contact us at (310) 829-9396 if you have any issues downloading the forms or have questions about any particular form.

New Patient Questionnaire

Cancellation Policy

We are committed to providing you with exceptional care in a timely manner. For this reason, we have instituted a 24-hour cancellation policy for all appointments.

The office needs to be notified 24 hours prior to the appointment date in order to avoid a cancellation or no-show fee of $100.

We appreciate your understanding and cooperation.

Please download, read and sign the forms below.

Cancellation Policy Form