REQUESTS Dr. Chao & Dr. Pousti Patients For all record requests contact: Dr. Chao care of VedaNu Wellness 8901 Activity Road San Diego, CA 92126 Phone: (858) 222-2883 Email: info@vedanuwellness.com Dr. Brown Patients For all record requests contact: Daniel Brown, MD 4765 Carmel Mountain Road #103 San Diego, CA 92130 (619) 461-1500 Dr. Singer Patients For all record requests contact: Charleston Chua, MD 8200 La Mesa Blvd La Mesa, CA 91942 (858) 699-0707 adminSD@chuaplasticsurgery.com REFUND REQUEST FORMREFUND REQUEST FORM Payments made by Cash, Check or CareCredit will be refunded by mail via check. We will attempt to refund any credit card on file before sending a check. Patient Full Name(Required) First Middle Last Date of Birth(Required) MM slash DD slash YYYY Patient IDEmail Please provide if you would like a digital copy of your refund receipt.Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone(Required)Original Payment Method(Required)Please make a selectionCredit CardCheckCashOtherOther Payment MethodOriginal Payment Date (approximately) MM slash DD slash YYYY Expected Refund Due(Required)Notes Δ
