Agreement for all payments to Tampa Bay Body Sculpting
Surgical Procedure Deposit: All Procedures for Tampa Bay Body Sculpting will require a non-refundable deposit of $500.00 to secure the quoted price and the allotted appointment time. This deposit covers your consultation and pre-operative appointments, onboarding of medical history and patient intake, scheduling of surgeon and nursing staff, prescription and lab orders, surgical and anesthesia supply orders, and medical clearance.
Payment Schedule: • a $500.00 deposit to be made toward surgery to secure pricing and schedule surgery date • 50% of surgery must be paid 4 weeks prior to your surgery date • 100% of surgery must be paid 2 weeks prior to your surgery date.
Cancellation and Appointment Change Policy: Should Tampa Bay Body Sculpting require your procedure to be rescheduled, your funds put toward your procedure will be kept secure and recorded for the rescheduled date. If you choose to cancel your surgical appointment at any time, you will not be refunded any money that has been paid toward surgery up to that date of cancellation. If you choose to reschedule your surgery appointment, 14 days notice is required whereby a $500.00 rescheduling fee will be assessed for the newly scheduled date.
Labs and Medical Clearance: Labs must be completed and reviewed by Dr. Miles 2 weeks prior to your surgery date. If you have been instructed to obtain medical clearance, it must be completed and reviewed by Dr. Miles 2 weeks prior to your surgery date. Obtaining labs and medical clearance are the responsibility of the patient. If labs and/or medical clearance have not been obtained prior to your scheduled surgery date, a $500 rescheduling fee will be applied to your surgery balance.
Arrival: If you do not show up to your scheduled surgery date all funds paid up to that date of surgery will be forfeited. Patients are monitored prior to and throughout all surgical procedures. If surgery cannot be started or continued for the safety of the patient as decided by Dr. Miles, then your surgery will be rescheduled once you obtain Medical Clearance from your Primary Care Physician. Additional fees may apply for the use of anesthesia, Dr. and all Medical staff, and surgical supplies.
BMI: All patients are weighed on surgery day whereby weight must be within the BMI limits for the surgery you are scheduled for as discussed within your consultation. If BMI is higher than what was discussed at the initial consultation appointment then all areas quoted may not be completed at the surgery date and additional surgeries with additional surgery fees will be required to complete these areas. A new surgery quote will be given to you.
Acknowledgement: I attest and understand and have read the above stated terms and conditions that constitute a legally binding contract. I understand and accept these terms. An electronic signature holds as a binding contract for my acceptance of this
document. All payments for surgery at Tampa Bay Body Sculpting are “non-refundable”.