*Coolspa (Flatiron)* *Scheduling Agreement Form*
  • Scheduling Agreement

  • As a courtesy to our providers and patients, we require at least 2 business days’ notice for cancelling or rescheduling appointments. For example, all Monday & Tuesday appointments must be confirmed or rescheduled by the previous Thursday or Friday, within business hours, respectively, to avoid any fees.

    Missed, rescheduled, or cancelled complimentary consultations without 2 business days' notice will incur a fee of $150.00.

    Missed, rescheduled, or cancelled treatment(s) without 2 business days' notice will incur a fee of $250.00.

    All appointments require a credit card on file including complimentary appointments and services intended to be paid for with a gift card.

    Some of our services require a scheduling deposit at the time of booking.

    Scheduling deposits are applied towards your scheduled treatment. The scheduling deposit is nonrefundable.

    Please note that we do not accept third party financing for appointment deposits. Payments for procedures are non-refundable.

  • Consultations with Dr. David P. Rapaport are $500.00, due 2 business days prior to the scheduled appointment. The consultation fee is non-refundable. Your consultation fee is applicable to your quote for up to one year from the date of issuance.

    Dr. Mansher Singh offers complimentary consultations. However, please note that a valid credit card is required to schedule your appointment.

    Missed, rescheduled, or cancelled consultations without 2 business days' notice will incur a fee of $250.00.

    Missed, rescheduled, or cancelled treatment(s) without 2 business days' notice will incur a fee of $250.00.

    Credit card information is stored for securing your treatment pricing, appointment date/time, & for online purchases only. Please present your credit card at the time of service to pay for any balances on your account.

    I authorize the Practice & any of its Associates/Providers to keep my credit card information on file and to charge this card for any outstanding balances. Credit card information is stored for securing your treatment pricing, appointment date/time, and for online purchases only. Please present your credit card at the time of service to pay for any balances on your account.

  • My signature below indicates I have read, understand, and agree to the terms stated in this agreement.

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