Patient Registration

Payment and Cancellation Policies-Payment is expected from you in full at the time of service for all treatments. For your convenience, we accept cash, personal checks, Visa, MasterCard, American Express, and Discover. We request 24 hours notice for cancellation of any appointment. Failure to provide at least 24 hours cancellation notice may result in an advance deposit being required from you for future appointments. Your signature below indicates that you understand and accept these policies. Down below please type your initials and the date

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Notice Of Privacy Practices Acknowledgment-You understand that, under the Health Insurance Portability & Accountability Act of 1996 (HIPAA), you have certain rights to privacy regarding your protected health information. A copy of the Notice of Privacy Practices containing a more complete description of the uses and disclosures of your health information is available upon request. You understand that Aesthetic Medical Center has the right to change its Notice of Privacy Practices from time to time and that you may contact this organization at any time to obtain a current copy of its Notice of Privacy Practices. Down below please type your initials and the date.

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