David Rasmussen, MD, Board Certified Plastic Surgeon
(817) 469-1163

Patient Resources

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.


Care Credit

Helpful Links

American Society of Plastic Surgeons
The American Society for Aesthetic Plastic Surgery
American Association for Accreditation of Ambulatory Surgery Facilities
Obagi® Products
La Roche-Posay®