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(913) 754-4939

7901 W. 135th Street, Overland Park, KS 66223

  • About Us
    • Meet the Staff
    • Why Choose Dr. Surek?
    • Publications & Media
    • Patient Testimonials
  • Procedures
    • Breast
    • Face
    • Body
    • Injectables
  • Before & After
    • Breast Procedures
    • Face Procedures
    • Body Procedures
    • Injection Procedures
  • Skin Care Center
    • Skin Care Services
    • Skin Care Staff
    • Skin Care Products
  • Contact
  • About Us
    • Meet the Staff
    • Why Choose Dr. Surek?
    • Publications & Media
    • Patient Testimonials
  • Procedures
    • Breast
    • Face
    • Body
    • Injectables
  • Before & After
    • Breast Procedures
    • Face Procedures
    • Body Procedures
    • Injection Procedures
  • Skin Care Center
    • Skin Care Services
    • Skin Care Staff
    • Skin Care Products
  • Contact

Patient Forms

All new patients must fill out the forms in the new patient packet. Bring all of these forms to your initial visit along with your photo ID, insurance card and credit or debit card. We accept Visa, MasterCard, Discover and American Express.

Established patients, please bring your photo ID and insurance card.

  • New Patient Packet (PDF)
  • Financial Policy FAQ (PDF)
  • Financial Policy (PDF)
  • HIPAA Consent Form (PDF)
    (Click here to view the entire privacy policy.)
  • Cosmetic Surgery Financial Policy (PDF)

All files are in PDF file format. Click here to download Adobe Reader to view these documents.

Operative Consent

  • Blepharoplasty Consent (PDF)
  • Breast Implant Removal Consent (PDF)
  • Breast Reconstruction with Tissue Expander Consent (PDF)
  • Brow Lift Consent (PDF)
  • Facelift Consent (PDF)
  • Gynecomastia Consent (PDF)
  • Liposuction Consent (PDF)
  • Nasal Injury Repair Consent (PDF)
  • Nipple Reconstruction Consent (PDF)
  • Otoplasty Consent (PDF)
  • Reduction Mammoplasty Consent (PDF)
  • Rhinoplasty Consent (PDF)
  • Saline Breast Augmentation Consent (PDF)
  • Scar Revision Consent (PDF)
  • Silicone Breast Augmentation Consent (PDF)
  • Tip Rhinoplasty Consent (PDF)
  • HIPAA Consent Form (PDF)
    (Click here to view the entire privacy policy.)

All files are in PDF file format. Click here to download Adobe Reader to view these documents.

7901 W. 135th Street

Overland Park, KS 66223

(913) 754-4939

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  • Non-Discrimination Policy

Opening Hours

Monday 8:00am - 4:30pm
Tuesday 8:00am - 4:30pm
Wednesday 8:00am - 4:30pm
Thursday 8:00am - 4:30pm
Friday 8:00am - 4:30pm
Saturday Closed
Sunday Closed

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- Dr. Christopher Surek

Plastic & Reconstructive Surgery,

A Division of U.S. Dermatology Partners

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