St. Louis Dermatology Open House Cosmetic Deposit Form

Thank you for joining us at our Open House!

You are eligible for 20% off a future cosmetic procedure. To secure these savings, an initial deposit of $250 is required. Should you wish to reserve time for multiple procedures, a non-refundable deposit is required for each additional service. Simply list the cosmetic services you would like to book in the 'Cosmetic Service[s] section and adjust the quantity in the 'Deposit' section.

Once payment has been processed, a member of our team will reach out to schedule your procedure[s].

Your Name*

First NameLast Name

Your Date of Birth*

Date

Your Email Address *

Please double check your email is accurate. A receipt will be sent to the email provided.

Your Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Cosmetic Service[s]*

Please provide the name of the cosmetic service[s] you would like to book.

My Products*

Open House Cosmetic Deposit

$250 non-refundable deposit entitles the patient to the 20% Open House discount on a future cosmetic procedure. Each $250 deposit is allocated to secure one (1) primary procedure only and will be applied to the total amount due at time of service.

$250.00 Quantity
Item subtotal:$0.00

Total

$0.00

Credit Card

TERMS AND CONDITIONS: A member of our team will reach out to schedule your consultation. The deposit required to secure your appointment is strictly non-refundable under all circumstances and will be retained by the practice regardless of cancellation, rescheduling, or failure to appear. Should you be unable to undergo the originally scheduled procedure, the full amount of your deposit will be credited toward an alternative service or retail product; however, this credit is only applicable to the full, non-promotional, retail price of the substitute item and cannot be combined with any discounted offers. The initial deposit of $250 is allocated to secure one (1) primary procedure only and will be credited toward that service. Should you wish to reserve time for multiple procedures during the same appointment, a separate, non-refundable deposit is required for each additional service at the time of booking. Procedures and consultations may be performed on the same day if pre-procedural considerations have been adhered to and time allows. Please note that online booking is not available for Hair Transplant Services or Hair Restoration Membership programs. To initiate a consultation or service for either of these programs, you must contact a dedicated team member directly.

St. Louis Dermatology Center

Credit Card