Office Policies
Cancellation Policy
The Aesthetics Society requests at least 48 hours’ notice when canceling or rescheduling your appointment.
We will send a reminder via text or call 72 hours in advance to notify you of your appointments. Additionally, if we have your email on file, our scheduling system will automatically send you an email reminder 7 days prior to your appointment. We encourage you to contact us directly by phone if you need to cancel or reschedule your appointment. Please note that messaging us on Facebook or Instagram is not an acceptable method for canceling or rescheduling.
It is important to understand that appointments are challenging to fill on short notice, and last-minute cancellations can directly impact our providers’ livelihoods. Therefore, we ask that you schedule wisely.
If you cancel or reschedule your appointment with Alecia after the 48-hour cutoff, a fee of $100 will be charged. For all other providers, the fee will be $50 if the cancellation or rescheduling occurs after the 48-hour deadline.
If we are unable to process the fee on the card we have on file, you will need to provide an alternate form of payment to settle the outstanding balance. Please be aware that you will not be able to book another appointment until this payment is received.
**In the case of a medical emergency that prevents you from providing the 48-hour notice, please submit your medical receipt, and we will reschedule your appointment without requiring an additional deposit.**
Non-Disparagement and Acknowledgement of Results
Client acknowledges and agrees that while The Aesthetics Society strives to provide high-quality services, desired results are not guaranteed as outcomes may vary based on individual factors. In the event the Client has any concerns, questions, or issues regarding the services provided, the Client agrees to contact The Aesthetics Society directly to address and resolve such matters. The Client further agrees not to make or publish any false, misleading, or disparaging statements, whether written or verbal, about The Aesthetics Society, its staff, or its services, including but not limited to online reviews, social media posts, or other public forums. This clause is intended to ensure open communication and mutual respect between the Client and The Aesthetics Society.
Photo Release Form
I hereby grant and authorize The Aesthetics Society the right to take, edit, alter, copy, exhibit, publish, distribute, and use any and all photographs or videos taken of me for legally promotional materials. This includes, but is not limited to, newsletters, flyers, posters, brochures, advertisements, and submissions to websites and social media platforms, as well as other print and digital communications, without payment or any other consideration. This authorization extends to all languages, media, formats, and markets now known or that may be developed in the future. This authorization will continue indefinitely unless I revoke it in writing.
I understand and agree that these materials will become the property of The Aesthetics Society and will not be returned.
I hereby hold harmless and release The Aesthetics Society from all liability, petitions, and causes of action that I, my heirs, representatives, executors, administrators, or any other individuals may make on my behalf or on behalf of my estate.
I warrant that I am of legal age (18 years or older) and that I am competent to enter into this agreement. I have read this release before signing below, and I fully understand its contents, meaning, and implications.
Non-Disparagement and Acknowledgement of Results
Client acknowledges and agrees that while The Aesthetics Society strives to provide high-quality services, desired results are not guaranteed as outcomes may vary based on individual factors. In the event the Client has any concerns, questions, or issues regarding the services provided, the Client agrees to contact The Aesthetics Society directly to address and resolve such matters. The Client further agrees not to make or publish any false, misleading, or disparaging statements, whether written or verbal, about The Aesthetics Society, its staff, or its services, including but not limited to online reviews, social media posts, or other public forums. This clause is intended to ensure open communication and mutual respect between the Client and The Aesthetics Society.
General Consent Form
General Consent
In our ongoing efforts to provide you with the best possible service, we ask that you carefully review this consent form and ask any questions necessary to help you fully understand it. Please sign at the bottom only after careful review and consideration.
Disclosure of Medical History
I agree that I will disclose a full and accurate personal medical history, including any and all information regarding medical conditions and my use of medications, drugs, herbs, vitamins or other supplements of any kind. I understand that failure to do so may affect my treatment outcome and increase the likelihood or severity of complications.
Confidentiality
I understand that no information regarding services performed shall be released without my express consent except as follows: I authorize that copies of my records may be sent to another location if I seek additional treatment at that location. I understand that, in addition to authorized clinic personnel, the clinic’s medical director and consulting physicians shall have full access to my treatment records. I understand that appropriate medical review may be conducted to further the safety and efficacy of my practitioner’s services. I understand my practitioner may also provide limited patient information to various third-party vendors to provide database development and maintenance services, referral services or marketing research services. I understand that photographs may be taken to document treatment results, but they will not be released or used otherwise without my specific written consent. My practitioner will maintain file copies of all records for a minimum of three years.
Skin Care Products
I understand that some of the skin care products offered by my practitioner are professional strength and formulated to aggressively treat problem skin. I agree that I will use any skin care products obtained from the clinic in accordance with the instructions and directions provided to me by the clinic staff and only after becoming acquainted with the product and its recommended use. I realize that I may experience varying degrees of discomfort, redness, burning, peeling, itching, dryness or other symptoms, especially in the early stages of use. These symptoms should lessen and eventually subside as my skin tolerance develops. I understand that in unusual circumstances, the use of these professional strength products could be harmful and even cause injury to the skin (infection, discoloration, superficial scarring, etc.). I will discontinue use and notify my practitioner if any unusual or concerning irritation occurs. I will not use any of these professional strength products if I am nursing, pregnant or trying to become pregnant. I understand that long-term use is necessary to achieve and retain the desired benefits.
Continued Consent
I understand that my practitioner’s services generally consist of a series of treatment to achieve maximum benefit, and this consent shall apply to all services rendered to me by my practitioner, including ongoing or intermittent treatments.
Cancellation Policy
I agree to contact my practitioner at least 48 hours in advance if I need to cancel or reschedule my appointment. I understand that I may be required to pay a missed appointment fee. I understand that if I arrive more than 15 minutes late for my appointment I may be required to reschedule in order to avoid disrupting the appointments of other patients.
Non-Disparagement and Acknowledgement of Results
Client acknowledges and agrees that while The Aesthetics Society strives to provide high-quality services, desired results are not guaranteed as outcomes may vary based on individual factors. In the event the Client has any concerns, questions, or issues regarding the services provided, the Client agrees to contact The Aesthetics Society directly to address and resolve such matters. The Client further agrees not to make or publish any false, misleading, or disparaging statements, whether written or verbal, about The Aesthetics Society, its staff, or its services, including but not limited to online reviews, social media posts, or other public forums. This clause is intended to ensure open communication and mutual respect between the Client and The Aesthetics Society.
BY SIGNING BELOW, I ACKNOWLEDGE AND CERTIFY THAT I, , HAVE READ AND UNDERSTAND THE “CONSENT, RELEASE AND INDEMNITY AGREEMENT” FOR THIS PROCEDURE, AND THAT I AM SIGNING IT VOLUNTARILY.
HIPAA
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Notice of Privacy Practices describes how we may use and disclose your protected health/personal information (PHI) to carry out treatment, payment or business operations (TPO) and for other purposes that are permitted or required by law. It also describes our rights to access and control your protected information. Protected health/personal information is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.
1. Uses and Disclosures of Protected Health/Personal Information.
Your protected health/personal information may be used and disclosed by our medical director, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you to support business operations of this office, if requested by you to a finance company to pay for your care, and any other use required by law.
Treatment: We will use and disclose your protected health/personal information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, we would disclose your protected health/personal information, as necessary, if, as a result of our services, you require treatment by a physician. Your protected health/personal information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.
Payment: Your protected health/personal information will be used, if requested, to obtain payment for your services. For example, if you desire to finance the costs of your treatments, this may involve disclosing relevant protected private information in order to obtain approval.
Healthcare Operations: We may use or disclose, as needed, your protected health/personal information in order to support the business activities of this office. These activities include, but are not limited to, quality assessment activities, employee review activities, licensing, and conducting or arranging for other business activities. In addition, we may use a sign-in sheet at the registration desk where you will be asked to sign your name. We may also call you by name in the waiting room when we are ready to see you. We may use or disclose your protected health/personal information, as necessary, to contact you to remind you of your appointment. We may use or disclose your protected health/personal information in the following situations without your authorization. These situations include: as required by law; public health issues as required by law, communicable diseases; health oversight; abuse or neglect; Food and Drug Administration requirements; legal proceedings; law enforcement; coroners, funeral directors, and organ donation; research; criminal activity and national security; workersï¿1⁄2 compensation; inmates; required uses and disclosures. Under the law, we must make a disclosure to you and, when required by the Secretary of the Department of Health and Human Services, to investigate or determine our compliance with the requirements of Section 164.500.
Other Permitted and Required Uses and Disclosures will be made only with your consent, authorization or opportunity to object unless required by law.
You may revoke this authorization, at any time, in writing, except to the extent that this office has taken an action in reliance on the use or disclosure indicated in the authorization.
2. Your Rights
Following is a statement of your rights with respect to your protected health/personal information.
You have the right to inspect and copy your protected health/personal information. Under federal law, however, you may not inspect or copy the following records: information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health/personal information that is subject to law that prohibits access to protected health/personal information.
You have the right to require a restriction of your protected health/personal information. This means you may ask us not to use or disclose any part of your protected health/personal information for the purposes of treatment or healthcare operations. You may also request that any part of your protected health/personal information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.
We are not required to agree to a restriction that you may request. If our medical director believes it is in your best interest to permit use and disclosure of your protected health/personal information, your protected health/personal information will not be restricted. You then have the right to use another service provider.
You have the right to request to receive confidential communications from us by alternative means or at an alternative location. You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice alternatively, i.e., electronically.
You may have the right to amend your protected health/personal information. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to our statement and will provide you with a copy of any such rebuttal.
You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health/personal information.
We reserve the right to change the terms of this notice and will inform you by mail of any changes. You then have the right to object or withdraw as provided in this notice.
Complaints
You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our privacy contact of your complaint. We will not retaliate against you for filing a complaint.
3. Non-Disparagement and Acknowledgement of Results
Client acknowledges and agrees that while The Aesthetics Society strives to provide high-quality services, desired results are not guaranteed as outcomes may vary based on individual factors. In the event the Client has any concerns, questions, or issues regarding the services provided, the Client agrees to contact The Aesthetics Society directly to address and resolve such matters. The Client further agrees not to make or publish any false, misleading, or disparaging statements, whether written or verbal, about The Aesthetics Society, its staff, or its services, including but not limited to online reviews, social media posts, or other public forums. This clause is intended to ensure open communication and mutual respect between the Client and The Aesthetics Society.
