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Home
Meet Dr. Z
Practice Areas
Treatments
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Patient Resources
Contact

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NEW PATIENTS

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PERSONAL INFORMATION:

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CONTACT INFORMATION:

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EMERGENCY CONTACT:

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EMPLOYMENT INFORMATION:

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REFERRAL INFORMATION:

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MEDICAL HISTORY:

Are you pregnant?

Do you have children?

If Yes, how many?

Have you ever had any of the following conditions? (Check all that apply)

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Have you ever had surgery?

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Have you ever had anesthesia complications?

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Do you smoke?

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Are you allergic to any medications or local anesthesia?

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Z AESTHETIC DERMATOLOGY POLICY

Our goal is to provide quality medical care in a timely manner. In order to do so we have had to implement an appointment/ cancellation policy. This policy enables us to better utilize available appointments for our patients in need of medical care.

Appointment Deposit Policy: All appointments scheduled at Z Aesthetic Dermatology will require a 50% deposit at the time the appointment is being scheduled. All balances on procedures are due at the time of service.

Cancellation of an Appointment: In order to be respectful of the medical needs of Z Aesthetic Dermatology patients and service providers please be courteous and call our offices promptly if you are unable to attend an appointment. If it is necessary to cancel your scheduled appointment we require that you give 48-hour advance notice. Appointments are in high demand, and your early cancellation is appreciated.

How to Cancel Your Appointment: To cancel appointments please call 225-778-7540 for Z Aesthetic Dermatology appointment desk. If you do not reach the receptionist you may leave a detailed message on the voice mail. If notice needs to be provided during non-office hours, please leave a detailed voicemail including your name, date of birth, phone number and a brief message. You may not cancel via email or text reminder response.

Late Cancellations: Late cancellations will be considered a "No Show". "No Show" will forfeit their deposit for the appointment.

Photo Use: Z Aesthetic Dermatology has the right to use before-and-after photos, provided that the patient’s identity is neither disclosed nor apparent in the image(s).

Gift Cards and Credit on Accounts: All Gift cards and Credit on Accounts expire a year from date of purchase.