Financials
Total: {total}
Deposit Due (Today): {depositDue}
Balance Due: {balanceDue}
Important:
Doctor: Hernandez
Address: AV DE LAS ROSAS # 41 COL JARDIN, MATAMOROS TAMAULIPASP ZIP 87390
Please read the following information closely, sign to acknowledge and agree to the following.
TIME FOR LABS: 8am-5pm, a day before or day of surgery. Please be sure to be fasting for the labs and surgery. Please bring your Covid test results the day of your labs or day of surgery. Deposits are non-refundable, exchangeable, or transferable.
Promos not included: *NO ANESTHESIA, *NO LABS, *NO EKG
Rescheduling: You must notify our team of your intent to reschedule your surgery at least one week before your surgery date. If rescheduling after your surgery date a new deposit will be required.
Rescheduling Before surgery fee: $300
Rescheduling After surgery fee: $400
Confirmation: The doctor will contact you to confirm the appointment time. If you do not confirm the time with the doctor, you will lose your deposit and your surgery date will be cancelled.
Changes: To make any changes to your procedure, you must first contact your coordinator.
Add or Remove Procedures: If you wish to add and/or remove any procedure, you must first contact your coordinator even if you are already at the hospital. Remember there is a $200 modification fee to add and/or remove any procedure. Modification requests one week before your surgery date will not be guaranteed, however, we will do our best to accommodate.
Photos/Media: Photographs, videotapes and/or case histories may be used for examination, testing, publicity, credentialing, and/or certifying purpose. By signing this contract you grant Body By Doctor the use of media stated above. Body By Doctor will handle your media in a responsible matter while ensuring to protect your privacy and identity.
Remaining Balance: The payment type accepted by doctors is only cash. Direct deposits, transfers, mobile payments, debit/credit cards, or checks are not accepted.
Rearrange: If you wish to rebook with the same doctor a new deposit will be required. Currency: All prices stated on our website and in this contract are in U.S Dollars. (United States Currency)
After Surgery: Please remember that Body By Doctor is a 3rd party promoting agency. Any post surgery issues will need to be addressed with your surgeon and/or their offices. We ask that after your procedure, before you leave the premises, you ensure you have gathered the necessary information from your surgeon and/or surgery team to best address any medical needs post surgery.
CANCELLATION: Body By Doctor reserves the right to void this contract if an issue arises between patient and company. Body by doctor practices a 'zero-tolerance' policy towards aggressive or abusive behavior. This includes any personal, abusive, or threatening comments, bad language, physical contact, and aggressive gestures. In case you show this type of attitude Body By Doctor will cancel your surgery and your deposit will be not refund.
Chargeback Penalty: In the event of a charge back, all payments submitted to center will be forfeited to Body By Doctor. For those individuals who pay by credit card, debit card, or finance companies: you are not eligible for credit card challenge or "charge back" to the finance companies once the service is provided as per this Agreement. You hereby understand and agree that (1) dissatisfaction with a procedure due to personal taste or otherwise, or (2) cancellation of a procedure under this Agreement are not grounds to initiate a charge back with your credit card, debit card, or finance company. Patients who fraudulently initiate charge back transactions and/or fraudulently dispute charges or services will be prosecuted to the fullest extent of the law. In addition, a $100 fee will be assessed.
Body By Doctor Coordinator: {bbdCoordinator}
Body By Doctor
Independent Contractor Agreement
This Independent Contractor Agreement (the "Agreement") is entered into by {patientName} hereinafter referred to as the "Client," and {bbdCoordinator}, hereinafter referred to as the "Coordinator." Collectively, the Client and Coordinator may be referred to as the "Parties."
1. Nature of Relationship
1.1 The Coordinator acknowledges and agrees that they are an independent contractor and not an employee or agent of Body By Doctor.
1.2 The Coordinator is solely responsible for providing services to the Client, including but not limited to scheduling, rescheduling, and modifying surgery dates, providing quotes, and addressing client inquiries.
2. Coordination Services
2.1 The Coordinator will act as the primary point of contact for the Client throughout the coordination process.
2.2 Body By Doctor will not be involved in addressing or resolving issues that may arise during the coordination process. The Coordinator is solely responsible for handling and resolving any concerns or questions raised by the Client.
3. Limitation of Body By Doctor's Responsibilities
3.1 Body By Doctor's role is limited to setting surgery dates, providing quotes, and facilitating scheduling, rescheduling, and booking modifications. Body By Doctor will not be responsible for addressing, fixing, or managing any situations that may arise beyond the scope of these specific services.
3.2 Any additional information or guidance provided by the Coordinator to the Client is the sole responsibility of the Coordinator. Body By Doctor shall not be liable for the accuracy or consequences of such information.
4. Client's Sole Point of Contact
4.1 The Client agrees that the Coordinator is their sole point of contact for all matters related to the coordination of services.
4.2 Any concerns, questions, or issues regarding the coordination process must be directed to the Coordinator. Body By Doctor will not intervene in such matters, even if Coordinator is no longer providing services to Body By Doctor.
I certify I have read in its entirety and understand the agreement and I accept and agree to all the terms listed above.