Thomas J. Francel MD

Board Certified Plastic Surgeon

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Patient Registration Forms

Please print and fill out the following forms and make certain you bring them with you the day of your appointment. Please remember to bring a drivers license and your insurance card (if applicable to your procedure) to your visit. If you are seeing Dr. Francel for a cosmetic consultation, your $100 fee will be due at the time of your appointment.

Patients of Dr. Francel

If your visit is related to Surgery, Botox® Cosmetic, Dermal Fillers or Laser Treatments, please fill out the Dr. Francel Forms

Skin Care Patients

If your visit will include Chemical Peels, Microdermabrasion or general Skincare Consultation/Education, please fill out the Francel Aesthetics Form

**Please note that we have a waiting area with limited seating and no food or drink is allowed. We kindly ask that you make prior arrangements for child care as our waiting area is not equipped for small children.

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Contact Us

Dr. Thomas Francel
621 South New Ballas Road
Saint Louis, Missouri 63141

phone: (314) 251-6845
fax: (341) 251-5754
or visit our contact page

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