RSMD Medical Aesthetics

General and Financial Policies

HIPAA
I acknowledge receipt of RSMD Medical Aesthetics’ Notice of Privacy Practices.I acknowledge that the office of Dr. Rebecca Small is not responsible for messages sent to telephone numbers and/or email addresses supplied by me that may be shared with others or no longer belong to me.

OPEN PAYMENTS DATABASE
For informational purposes only, a link to the federal Centers for Medicare and Medicaid Services (CMS) Open Payments web page is provided here. The federal Physician Payments Sunshine Act requires that detailed information about payments and other transfers of value worth over ten dollars ($10) from manufacturers of drugs, medical devices, and biologicals to physicians and teaching hospitals be made available to the public.I understand that I may search this federal database for payments made to physicians and teaching hospitals by visiting: https://openpaymentsdata.cms.gov/

MEDICAL INFORMATION
I acknowledge that it is my responsibility to fully and accurately disclose my medical history, including but not limited to medical conditions, medication allergies, use of medications and supplements, and sun exposure. I understand that I must inform and update the RSMD Medical Aesthetics healthcare professional treating me of my current medical history at each visit. Failure to do so may affect treatment results and increase the likelihood of complications.I accept responsibility for adhering to all before and after instructions for my treatments.I understand that RSMD Medical Aesthetics does not accept or provide billing services for any type of insurance or third-party payer, and that all payments for services are my personal responsibility and are due prior to or at the time of treatment.I understand that I must contact Dr. Small/RSMD Medical Aesthetics directly by phone at (831) 475-1077 for any medical questions, problems, or concerns relating to my treatment or to change my appointment time.I understand that my treatments will be performed by one of RSMD Medical Aesthetics’ licensed providers, which may include a doctor, nurse, or esthetician, when appropriate.

FINANCIAL
Treatment series must start no later than 3 months from the date of purchase and must be completed within 12 months from the date of the first treatment. Unredeemed treatments expire 12 months from the date of purchase.Prices quoted at the time of treatment supersede all other written or verbal quotations and are subject to change at any time.No refunds will be issued. However, at RSMD Medical Aesthetics’ discretion, the credit balance for unredeemed treatments in a LASER series (including laser and intense pulsed light) may be transferred to other LASER treatments after redeemed treatments are prorated at the regular, undiscounted price.Consultation fees are nonrefundable and must be redeemed within 30 days from the date of consultation.

LATE ARRIVALS, CANCELLATION AND MISSED APPOINTMENT
Cancellations or changes with less than 48 hours’ notice, or missed appointments, may incur a fee of $50 for the first occurrence. Subsequent occurrences will incur a fee of $150, or, if your treatment is part of a series, your treatment will be forfeited.If you are more than 15 minutes late, your treatment may be rescheduled or forfeited at RSMD Medical Aesthetics’ discretion.

POLICY ACKNOWLEDGMENT
RSMD Medical Aesthetics reserves the right to modify these policies and treatment prices at any time without notice. These policies supersede all prior MBLA/RSMD policies, whether written or verbal.By acknowledging this Agreement, I confirm that I have fully read and understand its contents, have had the opportunity to ask questions, and agree to the policies of RSMD Medical Aesthetics.