TBBS Payment Form
  • TBBS Payment Form

  • PAYMENT AGREEMENT & DISCLOSURE 
    By making a payment to Tampa Bay Body Sculpting (“TBBS”), Patient agrees to the service or procedure outlined and acknowledges that payment secures administrative time, scheduling coordination, and third-party arrangements. All payments are final and non-refundable, regardless of payment method, including deposits, consultation fees, and surgical fees.  If Patient cancels at any time, no refunds will be issued. To reschedule, Patient must provide at least 14 days’ notice, and a rescheduling fee will apply. Failure to provide proper notice or failure to appear for surgery will result in forfeiture of all funds paid. TBBS maintains a zero-tolerance policy for chargebacks. By making payment, Patient waives the right to initiate any chargeback or payment dispute for any reason. Any chargeback may result in administrative, legal, and collection fees and may be pursued to the fullest extent permitted by law.  Patient acknowledges that TBBS is not a medical provider and does not practice medicine or provide medical advice, diagnosis, or treatment. All medical services, procedures, anesthesia, and post-operative care are provided solely by Dr. Solomon and his clinic, who are independent medical providers and solely responsible for all medical decisions and outcomes.  Patient grants TBBS permission to take and use photographs and/or videos for marketing and promotional purposes, including but not limited to social media, advertisements (digital and print), website content, and educational or promotional materials.

    By signing or electronically accepting this Agreement, Patient confirms they have read, understood, and agreed to all terms. This Agreement is legally binding, and an electronic signature has the same legal effect as a handwritten signature.

     

     

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    After submitting the form, you will be redirected to Apple Pay to complete the payment.
    After submitting the form, you will be redirected to Google Pay to complete the payment.
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