Policies and Patient Forms

Patient Forms

• Authorization Personal Health Information
• Cosmetic Patient Registration
• Financial Responsibility Consent Form
• Notice of Privacy Acknowledgement
• Patient Registration

Policies

Cancellation and Late Arrival Policy

MEDICAL APPOINTMENTS:

We require two business days’ notice to reschedule or cancel medical appointments or you may be assessed a $75 cancellation fee.

COSMETIC APPOINTMENTS:

We require at least 48 hours’ notice to reschedule or cancel a cosmetic appointment. For late appointment changes or failure to keep a cosmetic appointment, we reserve the right to charge in full for the amount of the scheduled procedure.

Botox – Fillers – Laser Treatments – Peels – Microneedling

COSMETIC CONSULTATION:

We will only accept Cash or Credit Card for your first initial visit. Any visit thereafter, will will accept Cash, Credit Card or Check.

LATE ARRIVALS / LATE CANCELLATIONS / “NO SHOWS’

When a patient is more than 20 minutes late, we reserve the right to shorten or reschedule their appointment, so as not to inconvenience other patients. If a patient has three instances of late cancellations and/or failure to keep appointments, they will be referred to another clinic for their care

SCHEDULE DELAYS:

Our goal is to maintain a punctual schedule. Thank you for understanding that urgent medical conditions may occur which create unavoidable delays in the schedule.

If you should have any questions please contact us at (253)­ 460-5935 for further information.