luxe Concierge Care

CLIENT FORMS

Submit all completed forms to info@luxeconciergecare.com
Please complete and submit all forms at least 2 week prior to your surgery date.
If you have any questions please contact us at (813) 616-2890

NOTICE OF PRIVACY PRACTICES

CONSENT TO TREAT

CONSENT FOR USE OF HEALTH INFORMATION

FINANCIAL POLICIES

OFFICE POLICIES

CLIENT INTAKE FORM

PAYMENT

A 50% non-refundable deposit is required at the time of booking to reserve your appointment. The full balance must be paid 2 weeks prior to your surgery date. Deposits and payments are non-refundable.
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