FINANCIAL & OFFICE POLICY
All non-surgical procedures and retail products are due at the time services are rendered. For surgical procedures, full payment must be made 2 weeks prior to surgery schedule date. Our offices gladly accept Visa, Mastercard, Discover, American Express, Cash, Cashier's Check, Personal Checks, Money Orders, and Care Credit.
If you would like to apply for United Medical Credit, Prosper Healthcare Lending, Care Credit, and Simple Pay financing, please consult with our Financial Coordinator. United Medical Credit, Prosper Healthcare Lending, and Simple Pay payments are acceptable for surgical procedures only.
Unfortunately, we do not accept any healthcare insurance and will not file healthcare insurance claims.
Complete Laser Clinic reserves and will exercise the right to report any account 90 days past due to Collections Agency. All expenses incurred as a result will be the patient's responsibility, as permitted by law. There will also be a 1.8% monthly finance charge on all delinquent accounts along with all court and attorney fees or other fees associated with the collection accounts.
NO REFUND OR RETURN POLICY
Complete Laser Clinic does not guarantee the outcome of any procedure or product purchased. Please read over your consents carefully and ask any questions before you decide on any service(s), service package(s), gift certificate(s), and/or retail products(s).
At Complete Laser Clinic, we reserved your appointment especially just for you. We would appreciate your understanding and cooperation with regard to cancellation. Right now, there is no fee for cancellations and help us keep it this way by notifying us at least 24 hours prior to your scheduled time and at least 2 weeks prior for surgical procedures. If surgical appointments are not cancelled or rescheduled at least 2 weeks prior to your schedule date, your surgery deposit will be non-refundable.
All consultations except for Reshape are free of charge. Consultation fee for Reshape is $150.00. Consultations on any surgery must be completed in person with the surgeons. If a virtual consultation was given, patient is still required to meet the surgeon at least 1 day prior to surgery. Final approval on surgery is up to the surgeons. If final approval on surgery is denied related to your labs and ekg, your surgery deposit will be non-refundable if you miss the 2 weeks cut-off date.
Any quotation given by Complete Laser Clinic is merely an invitation for provision of products or procedures to your specification and shall not give rise to any contract. Complete Laser Clinic reserves the right to vary or withdraw a quotation at any time prior to giving the products or performing the procedures. All quotations and cost estimates are without obligation.
You must notify Complete Laser Clinic of your acceptance of the quote within thirty (30) days of the date. After 30 days, all prices may be subject to change. Acceptance of a surgical procedure quote must be place with a surgery deposit. A surgery deposit of $500.00 is required for awake procedures and $1,500.00 for sedated procedures.
The surgery deposit will be deducted from your total procedure cost; therefore, leaving the remaining balance of the procedure cost due 2 weeks prior to surgery schedule date. However, if you fail to cancel or change your appointment date within 2 week of original scheduled surgery date, the surgery deposit will be non-refundable. In the event that the surgery deposit is marked as non-refundable, a new surgery deposit will be required in order to reschedule another surgery date. Final approval on surgery is up to the surgeons. If final approval on surgery is denied related to your labs and ekg, your surgery deposit will be non-refundable if you miss the 2 weeks cut-off date.
MONTHLY SPECIAL PRICINGS
Monthly special pricings are time framed pricings that are available to new and existing patients and valid from the beginning of the month until the end the month. After the end of the month, all special prices will expire.
1-DAY SPECIAL PRICINGS
1-Day special pricings are time framed pricings that are available to new and existing patients and valid from 9:00 a.m. until the end of the office's closing hours. After the end of the office's closing hours, all special prices will expire.
Disability or FMLA Request $50.00
Copy of Medical Record $10.00 minimum or $0.75 for the first 25 pages, $0.50 for page 26-100, and $0.25 for over 101 pages whichever is greater.
AUTHORIZATION AND RELEASE
I affirm that the information given is correct to the best of my knowledge. It will be held in confidence and it is my responsibility to inform to office in any changes of address, phones, employment information, and medical status.
I have read all the questionnaires and disclosed my medical history to the best of my knowledge.
I understand that Complete Laser Clinic does not accept any healthcare insurance nor process any healthcare insurance claim. I understand that I am financially responsible for all services performed and that the full balance of treatment is due at the time service is rendered.
I understand that I am responsible for the full balance, including but not limited to late payment fees, third party collection fees, court fees, filing fees, and attorney fees.
I authorize Complete Laser Clinic staffs to perform all necessary medical services needed. Like all treatments of the body, there are certain risks, benefits, limitations, and alternatives to treatment and no guarantee of the outcomes or cures will be given.
I understand it is difficult to predict any symptoms, if any, I may encounter as a result of treatment.
I am agreeing that any service(s), service package(s), gift certificate(s), and/or retail products(s) I purchase at Complete Laser Clinic is a final sale. I understand any and all service(s), service package(s), gift certificate(s), and/or retail products(s) purchased will not be refunded or issued a credit.
I understand that this will forms a binding agreement between Complete Laser Clinic and myself as the patient who is receiving medical services and I agree to accept full financial responsibility as a patient who is receiving medical services. My signature below verifies that I have read the above disclosure statement, understand my responsibilities, and agree to these terms.
After reviewing the terms & conditions, please accept if you agree with and you will be redirected to our payment gateway.*
I agree to the terms and conditions