FINANCIAL POLICY FOR DEPOSITS AND SURGERY
It is important to us that patients fully understand their financial obligations, along with our payment, cancellation and rescheduling policies prior to undergoing surgery with Hudson Facial Plastic Surgery, LLC.
When you schedule surgery we must reserve time in the operating room. Dr. Hudson has secured operating room time involving surgical nurses, technicians, and anesthesia providers to be available. Furthermore, we must turn away every other patient who wants surgery on the day and the time we have reserved on your behalf. Based on both the financial and time commitments Dr. Hudson must make, we ask that you be definite about your desire for surgery, and certain you have the funds available before scheduling your surgery.
The Surgical Deposit Agreement is outlined below. When you feel you understand the contents of this form, and agree to the terms, please sign on the line indicated.
I understand that:
My surgery is scheduled with Dr. Hudson, and I have reserved the operating room/office procedure room on a specific date for my surgery. Hence, upon scheduling, it is no longer available to other patients. Therefore, I agree to submit a $2,000 surgical deposit at the time I request my surgery to be scheduled. If your procedure is less than $4,000, one half the surgical fee is required. All surgical fees must be paid for no less than four weeks prior to the date of your surgery.
Cancellation and Rescheduling Policy For Surgical Deposit and Surgeon’s Fee:
Cancellation or rescheduling at least 29 days prior to date of surgery:
- Full refund of deposit and any previously paid procedure fees
Cancellation 28-22 days prior to date of surgery:
- Forfeiture of deposit
- Any additional previously paid procedure fees are to be refunded
Rescheduling 28-22 days prior to date of surgery:
- $500 rescheduling fee
- Deposit becomes non-refundable regardless of new date of surgery
- Remaining procedure fees are due 29 days prior to new date of surgery
Cancellation 21-15 days prior to date of surgery:
- Forfeiture of deposit and 25% loss of all remaining procedure fees.
Rescheduling 21-15 days prior to date of surgery:
- $500 rescheduling fee
- Deposit becomes non-refundable regardless of new date of surgery
- 25% of all remaining procedure fees become non-refundable regardless of new date of surgery
Cancellation 14-2 days prior to date of surgery:
- Forfeiture of deposit and 50% loss of all remaining procedure fees.
Rescheduling 14-2 days prior to date of surgery:
- $500 rescheduling fee
- Deposit becomes non-refundable regardless of new date of surgery
- 50% of all remaining procedure fees become non-refundable regardless of new date of surgery
Cancellation 1 day or less from date of surgery:
- 100% loss of all fees.
Rescheduling your surgery more than once – Rescheduling Fee of $300
There will be no funds held back in the event of rescheduling or cancellation by Hudson Facial Plastic Surgery LLC.
There will be no funds held back if the patient is medically unable to undergo surgery due to a documentable medical reason with a treating doctor’s statement, and we are notified at least 8 days prior to the date of surgery.
If the patient is medically unable to undergo surgery due to a documentable medical reason with a treating doctor’s statement, and we are notified 7 days or less prior to the date of surgery, all funds will be returned minus $850.
“Procedure Fees” shall mean the total amount quoted for the entire procedure, including the surgeon’s fee, the anesthesia fee, and facility fee.
Additional Surgery Necessary:
There are many variable conditions that may influence the long-term result from your cosmetic surgery. Secondary surgery may be necessary to obtain optimal results. Should complications occur, additional surgery or other treatments may be necessary. Any revision or secondary surgery is at the discretion of the patient, who is financially responsible for any subsequent surgeries.
I hereby acknowledge that I have received a copy of my surgical quote and payment policies and that I understand and accept the terms listed.
If you have any questions about our Financial Policy, please call our office at 312-929-2661.