Arlington Cosmetic Surgery Center
Dr. David Rasmussen
1017 W. Randol Mill Rd. | Arlington, TX 76012 | 817-469-1163
Patient Resources
Patient Forms
You may download, print and fill out the forms below and bring into Dr. Rasmussen’s office on the day of your consultation. For any questions, please give us a call at 817-469-1163 or e-mail us: apsa@swbell.net
Notice of Privacy Practices
HIPPA acknowledgment
Consent Form
Patient Information
Medical History
Photo Consent
Financial Policy
Our initial consultation fee is $50.00. When surgery is scheduled within six months of the consultation, the fee will be applied to the cost of the surgery.
Full payment is expected 2 weeks prior to the surgery. Cash, checks and major credit cards are accepted.
Financing:
Care Credit
1-800-365-8295
Helpful Links
American Society of Plastic Surgeons
The American Society for Aesthetic Plastic Surgery
American Association for Accreditation of Ambulatory Surgery Facilities
Restylane®
Juvederm®
Botox®
Obagi® Products
Dermologica®
La Roche-Posay®
Designed for Dr. David Rasmussen by the American Society of Plastic Surgeons