Thank you for choosing us as provider. Our goal is to provide you with highest quality care at affordable cost. To make our services available to as many patients as possible on an affordable basis, we have adopted a financial collection policy outlined below. We ask you to read the policy carefully and sign prior to any treatment.

PLEASE NOTE THAT WE DO NOT GIVE REFUNDS ON ANY SERVICE

We accept cash AMEX, Visa and MasterCard. A 50% deposit will be required to schedule appointment and applied to services provided, which is refundable if procedure cancelled within 48 hours of appointment. Payment is due at the time of service.

Cancellations within 24-48hours will be required to pay 50% of treatment cost. 

Cancellations within 24 hours/No Shows will be required to pay 100% of treatment cost.

If you cancel within the 48 hour period on two occasions, you will be required to pay in advance for your next treatment.

If any credit card payments are declined, we will require payment balance to be made in full before booking another appointment or will be sent to collections if not resolved within 24hours.

Our charges under this agreement only include the charges for the stated date of services at this facility and do not include charges for any other date of services whether from us or any other providers and/or facilities.

ADDITIONAL PROVISIONS

1.         In the event that any of the terms, covenants or conditions contained in this Agreement is held to be invalid, then any such invalidity shall not affect any other term, covenant or condition contained herein which shall remain in full force and effect, unless such term, covenant or condition is material to the intent of this Agreement.

2.         You agree that if a lawsuit is filed to collect fees owed by you and/or to enforce this Agreement, the prevailing party shall have the right to collect from the other party its reasonable costs and attorney's' fees incurred in enforcing this Financial Policy and Agreement.

This Financial Policy and Agreement contains the entire agreement of the parties with respect to the subject matter of the Financial Policy.  This agreement supersedes any prior agreements, understandings, or negotiations, whether written or oral.  This agreement can only be amended through a written document formally executed by all parties.

We are committed to serving you with highest quality care possible at affordable cost. Every staff member at our office is ready to help you at all times. If you have any questions regarding our financial policies, please do not hesitate to ask us at any time. We thank you for your co-operation.

I have read and understand this Financial Policy and Agreement.

I authorize Livia Med Spa/Angela Spicola, APRN to charge my credit card for no-show appointments, late cancellation fees, and statement balances.