This Patient Surgical Agreement – Terms and Conditions (the “Agreement”) is made and entered into between the Company identified on the Invoice signed by Patient and the individual signing the Invoice (the “Patient”).
3.1. In General. To schedule a surgery with Company, Patient shall pay the Booking Fee listed on Patient’s Invoice. The Booking Fee is NON-REFUNDABLE. The Booking Fee compensates Company for all expenses (administrative and otherwise) relating to all necessary work that has been undertaken from the time of Patient’s inquiry up through and including booking the Patient for surgery.
3.2. Time Frame. Upon payment of the Booking Fee, Patient shall have twelve (12) months from the date of payment of the Booking Fee to schedule and undergo surgery. Subject to the terms of this Agreement, if Patient’s surgery does not take place within twelve (12) months from the date of payment of the Booking Fee, then the Booking Fee shall be deemed forfeited, and a new Booking Fee shall be required. Additionally, depending upon the time frame in which a surgery is cancelled or rescheduled, there may also be additional fees and costs assessed against Patient pursuant to the terms of this Agreement.
3.3. Forfeiture. If Patient elects to forfeit Patient’s Booking Fee, then Patient shall not be permitted to schedule or reschedule any surgery at Company within 90 days of forfeiture.
4.1. Change of Surgeon. Any change by Patient to the surgeon listed on the Invoice will result in a $1,000 change fee ONLY if Patient chooses a surgeon that is less expensive than the surgeon initially chosen by Patient as reflected in the Invoice. However, should the surgeon listed on Patient’s Invoice become unavailable and/or unable to perform Patient’s Services, then Company reserves the sole and absolute right to select a different surgeon to perform Patient’s Services at no additional cost to Patient. Any change of surgeon initiated by Company shall not serve as a basis for Patient to cancel or reschedule any of the Services.
4.2. Change of Surgery Date. Patient may reschedule his or her surgery without penalty with at least 60 days’ notice of the surgery date that is initially scheduled by Patient. Should Patient reschedule Patient’s surgical procedure within 60 days of the original surgery date, then Patient understands and agrees that Patient shall be subject to an additional $500 rescheduling fee. Notwithstanding the above, in the event that a conflict or other such reason arises on the Company’s end with respect to Patient’s surgery date, Company reserves the sole and absolute right to change Patient’s surgery date at no additional cost to Patient. Company will take all reasonable steps to minimize any changes made by Company to Patient’s surgery date. Any change of surgery date initiated by Company shall not serve as a basis for Patient to cancel or reschedule any of the Services.
4.3. Change of Location. Once Patient has scheduled the Services, any change by Patient to the location in which the Services are to be performed will result in a $1,000 change fee. Company reserves the right to increase this fee at any time without prior notice to Patient. Notwithstanding the above, in the event that a conflict or other such reason arises on the Company’s end with respect to the location in which Patient is scheduled to undergo the Services, Company reserves the sole and absolute right to change the location at which Patient’s Services will be performed at no additional cost to Patient. Any change of location initiated by Company shall not serve as a basis for Patient to cancel or reschedule any of the Services.
4.4. Change of Services or Surgical Plan. If Patient elects to change the surgical plan, then Patient shall be subject to an additional $500 change fee ONLY if the change results in a less expensive procedure than initially chosen by Patient as reflected in the Invoice. Additionally, Patient understands and agrees that, consistent with Section 13 of this Agreement, the recommended surgical procedure may be changed the day of surgery, subject to the surgeon’s discretion, which may result in additional costs to Patient. If Patient’s surgical procedure is changed the day of surgery pursuant to the surgeon’s recommendation, then Company will honor the retail price for that surgical procedure as of the date of Patient’s initial Invoice.
4.5. Cancellation. Patient may cancel his or her surgery without penalty with at least 60 days’ notice of the surgery date that is initially scheduled by Patient. Should Patient cancel Patient’s surgical procedure within 60 days of the original surgery date, then Patient understands and agrees that Patient shall be subject to an additional $500 cancellation fee.
5.1. In General. Patient understands and accepts that problems relating to or complications arising from your surgery may result in additional fees and costs to be assessed against Patient. These costs may include additional anesthesia and facility fees, hospital costs, physician’s and surgeon’s fees and/or other charges. Patient is solely responsible for these fees and costs.
5.2. Cell Saver. Any patient with a hemoglobin level between 11.0 and 11.9, as determined by the laboratory results submitted to Company within the time frame required by Company, will require the use of Cell Saver. Notwithstanding, at the surgeon’s sole and absolute discretion, the surgeon may determine that the use of Cell Saver will be required for Patient’s surgery regardless of Patient’s hemoglobin level. Patient shall be responsible for paying the NON-REFUNDABLE $500 fee for the use of Cell Saver during Patient’s surgery. Failure by Patient to pay for Cell Saver prior to surgery will result in the cancellation of Patient’s surgery. Patient shall not be entitled to any refund of this fee if Cell Saver is not actually used on Patient during Patient’s surgery. The non-refundable nature of this fee is due to the costs associated with keeping Cell Saver on standby for Patient during Patient’s surgery.
6.1. Direct Payments. Subject to Section 8 of this Agreement, Company accepts payments in cash (U.S. Dollars) and the following credit cards: Visa, Master Card, Discover, and American Express. Personal, business, or cashier’s checks ARE NOT ACCEPTED BY COMPANY. With respect to payment of the Booking Fee only, Patient may be permitted to pay the Booking Fee via money order, which must be sent at least 45 days before Patient’s scheduled surgery to the following address: 14000 SW 119th Ave Miami, FL 33186. Other than for payment of the Booking Fee, Company does not accept money order as a valid form of payment. If sending payment by mail, then Company recommends that Patient include a tracking number for Patient’s own safety and ability to track the payment. Company is not responsible for lost payments sent by mail. If a third party is paying on Patient’s behalf, that third party must provide a government issued identification AND a credit card that matches the name on the government issued identification. FAILURE TO COMPLY WITH THESE REQUIREMENTS WILL RESULT IN THE IMMEDIATE CANCELLATION OF PATIENT’S SURGERY AND PATIENT’S NON-REFUNDABLE BOOKING FEE SHALL BE DEEMED FORFEITED.
6.2. Payments Through Third-Party Lenders. Subject to Section 8 of this Agreement, Company requires that payments from finance companies be made no earlier than 30 days and no later than 10 days prior to the date of surgery. Please keep in mind that Company DOES NOT take payments from third-party lenders on weekends and that such payments can only be made during business hours Monday through Friday. Before Company will accept any financing payments, Patient must first send a legible copy of a valid government issued identification to Company, as instructed by Company. Additionally, Patient must be an authorized cardholder. If a third party is paying on Patient’s behalf, that third party must provide a government issued identification AND a credit card that matches the name on the government issued identification. FAILURE TO COMPLY WITH THESE REQUIREMENTS WILL RESULT IN THE IMMEDIATE CANCELLATION OF PATIENT’S SURGERY AND PATIENT’S NON-REFUNDABLE BOOKING FEE SHALL BE DEEMED FORFEITED.
6.3. Forfeiture of Monies. If Patient fails to undergo the surgical procedure stated in Patient’s Invoice within twelve (12) months from the date of payment of the Booking Fee, then ALL monies paid to Company shall be deemed forfeited by Patient and Company shall be entitled to retain ALL monies paid by Patient without any refund to Patient.
11.1. BMI Requirements for Surgery. For any surgery that INCLUDES a Tummy Tuck/Abdominoplasty, Patient MUST have a Body Mass Index (“BMI”) of 32 or less on the day of Patient’s pre-operative appointment. For any surgery that DOES NOT include a Tummy Tuck/Abdominoplasty, Patient MUST have a BMI of 34 or less on day of Patient’s pre-operative appointment. Patient’s surgery will be cancelled if Patient does not meet the BMI requirement on the day of Patient’s pre-operative appointment. At Physician’s medical discretion, Physician may elect to make exceptions to this baseline requirement. If Patient does not call and reschedule Patient’s surgery within 48 hours, which surgery shall take place within the 12-month window provided by Section 3, then Patient shall be refunded all monies paid with the exception of the Non-Refundable Booking Fee and a $2,500 cancellation fee. If Patient calls and reschedules Patient’s surgery within 48 hours, which surgery date is within the 12-month window provided by Section 3, then Patient shall not be subject to the cancellation fee so long as all monies paid by Patient (or on behalf of Patient) to Company remain with Company and are not disputed by Patient. If the 12-month window provided by Section 3 has elapsed, then Patient must be issued a new Invoice, including a new Booking Fee, to reschedule any services at the then-current rate, and any monies previously paid to Company (not including the Booking Fee) shall be applied towards the new Invoice.
11.2. Pregnancy Prior to Surgery. Patient is not authorized to undergo surgery if pregnant. Additionally, if Patient is diagnosed with a pregnancy that results in a failed pregnancy, miscarriage or termination at any time within 6 months of the scheduled date of surgery, then Patient’s surgery must be rescheduled within the time frame provided by Section 3. Additionally, Patient agrees to have a pregnancy test administered by Company on the day of surgery prior to the start of the surgery. In the event the test is positive, Patient’s surgery will be immediately cancelled. If Patient is cancelled the day of surgery due to a positive pregnancy test, then Patient shall be required to pay a $2,500 cancellation fee in addition to the Non-Refundable Booking Fee. However, if Patient elects to reschedule the surgical procedure in lieu of requesting a refund, then Company may agree to a one-time waiver of the cancellation fee and any new Booking Fee and may grant Patient a one-time courtesy 18-month contract extension to allow Patient to reschedule the surgical procedure. If Patient elects to proceed with the rescheduling of the surgery, then Patient understands that, should cancellation occur for any reason, Patient shall be required to pay a $2,500 cancellation fee in addition to the Non-Refundable Booking Fee.
11.3. Hemoglobin or A1C Levels. Any Patient with a hemoglobin level of less than 11.0 as determined by the laboratory results submitted to Company within the time frame required by Company will be cancelled and may be rescheduled by Patient within the time frame provided by Section 3, which may be subject to additional fees. However, a Patient whose Services only include a Breast Augmentation may have a hemoglobin level of less than 11.0. Patient must not have an A1C level higher than 6.9 as determined by the laboratory results submitted to Company within the time frame required by Company, otherwise Patient’s surgery will be cancelled and may be rescheduled by Patient within the time frame provided by Section 3 of this Agreement, which may be subject to additional fees.
11.4. Medications for Pre-Existing Conditions. If Patient has been diagnosed with a pre-existing medical condition that can be regulated or controlled, Patient must seek additional treatment from Patient’s primary doctor to control the condition, which may include taking prescribed medications, before scheduling or rescheduling Patient’s Services.
11.5. Drug Test. Patient agrees to have a drug test administered by Company on the day of surgery prior to the start of the surgery. In the event the drug test is positive, Patient’s surgery will be immediately cancelled, and all monies paid to Company shall be deemed forfeited without any refund to Patient. However, if Patient decides to reschedule the Services, then Patient shall be required to pay an additional $1,500.00 rescheduling fee, and the monies previously paid to Company will be applied toward the Services.
11.6. Nicotine Test. Patient agrees to have a nicotine test administered by Company on the day of surgery prior to the start of the surgery. In the event the test is positive, Patient’s surgery will be immediately cancelled, and all monies paid to Company shall be deemed forfeited without any refund to Patient. At Physician’s medical discretion, Physician may elect to make exceptions to this baseline requirement. However, if Patient decides to reschedule the Services, then Patient shall be required to pay an additional $750.00 rescheduling fee, and the monies previously paid to Company will be applied toward the Services.
17.1. Post-Surgical or Lymphatic Massages. Company may provide Patient with the option to purchase post-surgical or lymphatic massages to expedite recovery after surgery. Patient understands that this massage is not a traditional massage and will ONLY last 20 minutes. ALL MASSAGES ARE NON-REFUNDABLE.
17.2. Surgical Accessories. Surgical accessories are NON-REFUNDABLE and NON-TRANSFERRABLE (i.e., they may not be transferred by Patient to another person).
19.1. In General. All plastic surgery treatments and operations are performed to improve an unsatisfactory area on Patient’s body with a very high probability of success. Patient must understand that the outcome of the procedure is dependent upon various factors, many of which are outside of Company’s control. To that end, Patient must be realistic in the outcome likely to be achieved by Patient based on Patient’s body type, Patient’s history and other factors within Patient’s sole control. Notwithstanding, Company understands that a Patient may not always achieve the desired result. In certain cases, the surgeon that performed Patient’s surgery, in his/her sole discretion, may elect to provide a touch-up procedure to Patient within one (1) year from the date of Patient’s surgery, which shall be subject to the fees and costs set forth herein. However, if after approving a touch-up procedure, the surgeon that performed Patient’s surgery is no longer employed by Company, then Patient shall not be entitled to receive a touch-up procedure.
19.2. Fees & Costs. If the touch-up procedure by the surgeon that performed Patient’s initial procedure requires Patient to be placed under general anesthesia, as determined by the sole discretion of the surgeon, then: Patient shall be required to pay an operating fee between $2,500-$3,500, which includes the costs for the operating room and general anesthesia. If the touch-up procedure by the surgeon that performed Patient’s initial procedure does not require Patient to be placed under general anesthesia, but can instead be performed under local anesthesia, as determined by the sole discretion of the surgeon, then: Patient shall be required to pay an operating fee between $1,500-$2,000, which includes the costs for the operating room and local anesthesia.
19.3. Exclusions; Additional Fees & Costs. Any touch-up procedure does NOT include any additional services that were not part of the initial surgical procedure or any products or materials utilized by the surgeon to give the Patient the desired result (including, but not limited to, an implant, upgraded implant or mesh). Additionally, before undergoing a touch-up procedure, Patient must still comply with all laboratory tests and medical clearances required by the terms of this Agreement. Further, Patient may be required to pay additional fees required by Section 5.2 (Cell Saver) in connection with the touch-up procedure. Company is not responsible for any fees or costs relating to a touch-up procedure.
21.1. In General. Company understands that situations arise that may force Patient to postpone Patient’s Services. Patient must understand that such changes affect the surgeon, operating room staff, Company staff, and other patients. The surgeon’s time, as well as that of the operating room staff’s, is precious and Company requests Patient’s courtesy and concern.
21.2. Policies. The following are the Company’s cancellation and refund policies, which are subject to the terms and conditions as set forth in this Agreement:
21.3. Exceptions. To follow are the exceptions to the Company’s cancellation and refund policies, as set forth in this Agreement:
21.4. Time Frame for Issuance of Refund. Processing eligible refunds may take 45 days or more to be issued.
The Parties further agree that any such claims or disputes shall be resolved by MANDATORY AND BINDING ARBITRATION, in accordance with the Federal Arbitration Act (9 U.S.C. Section 1, et seq.) which shall apply to any such proceedings, including any actions to compel, enforce, vacate or confirm proceedings, awards, or orders of an arbitrator.
Both Parties to this Agreement confirm that they are entering into this BINDING ARBITRATION AGREEMENT on the advice of their respective counsel. Further, the Parties agree that the services provided under this Agreement and subject to this arbitration agreement involve and affect interstate commerce.
Patient further acknowledges that by entering into and accepting this Agreement, the Patient is giving up any right he/she may have to sue or bring any claim in a court of law. Patient acknowledges that he/she is giving up constitutional rights to have his/her claims decided in a court of law or before a jury and instead accepts the use of BINDING ARBITRATION as the EXCLUSIVE means to resolve such disputes.
This Agreement shall bind the Parties, their heirs, successors, assigns and all claimants whose claims may arise out of or are related to treatment or services provided under this Agreement by the Company and its employees, agents, and any affiliated physicians providing health care or professional services to the Patient.
A claim shall be waived and forever barred if (1) on the date notice thereof is received, the claim, if asserted in a civil action, would be barred by the applicable Texas statute of limitations, or (2) the claimant fails to pursue the arbitration claim in accordance with the procedures prescribed herein with reasonable diligence.
The Parties further agree that instituting legal proceedings in any court by the Company or its affiliates to collect any fee or outstanding invoice owed as a result of the services provided under this Agreement shall not constitute a waiver of the right to arbitrate under this paragraph.
Notice of Arbitration: A demand for arbitration must be communicated in writing by U.S. mail, postage prepaid, to all Parties, describing the claim against the Company, the amount of damages sought, and the names, addresses and telephone numbers of the Patient, and (if applicable) his/her attorney.
Selection of Arbitrator: A single arbitrator will be designated to preside over the arbitration proceedings. The Parties shall make good faith efforts to jointly agree upon an arbitrator. The Arbitrator shall reside or have a principal place of business in one of the following Texas Counties: Collin County or Rockwall County. If the Parties are unable to agree on an arbitrator, then each of the Parties to the arbitration proceeding shall designate three (3) proposed arbitrators. Each Party will be able to veto or strike one proposed arbitrator and the names of the remaining four (4) proposed arbitrators shall be submitted to a Texas state court judge in Collin County, Texas who shall select a single arbitrator from the remaining proposed names to serve as the arbitrator. Alternatively, only upon agreement of both Parties, the Parties may agree to select an arbitrator from the remaining proposed names by any agreed method of chance. As an additional alternative, if the Parties are unable to agree to an arbitrator who resides or has a principal place of business in one of the aforementioned counties, only upon agreement of both Parties, the Parties may jointly agree to an arbitrator who resides or has a principal place of business in Texas.
Location of Arbitration: Arbitration shall take place in one of the following Texas Counties: Collin County or Rockwall County as prescribed by the arbitrator, or in any other County in the State of Texas upon the agreement of all Parties involved in the arbitration proceeding.
Authority of Arbitrator: The arbitrator shall render a binding and legally enforceable award that may be confirmed by a court of competent jurisdiction upon application of the prevailing party. Any decision rendered by the arbitrator shall be binding upon both Parties except that the arbitrator may not grant any relief that is inconsistent with the provisions of this Agreement and may not grant punitive or exemplary damages as a result of any claim.
Each Party retains the right to seek judicial assistance to: (i) compel arbitration; and (ii) enforce any decision of the arbitrator, including the final award.
Cost of Arbitration and Recoverable Attorney Fees – Each Party to the arbitration shall bear their own costs, fees, and expenses. The arbitrator’s fees and expenses and any associated arbitration costs shall be split by the Parties as follows: Plaintiff(s) are collectively responsible for 50% and Defendant(s) are collectively responsible for 50%.
In the event any provision(s) of this Agreement is declared void and/or unenforceable, such provision(s) shall be deemed severed therefrom and the remainder of the Agreement enforced in accordance with the law of the state of jurisdiction.