By agreeing to these terms and conditions you OPT-IN to being contacted by International Metabolic Bariatric Center SC via Text Messages, Email, WhatsApp, and/or Phone. To opt-out, simply reply "STOP". Your information is NEVER sold or used by 3rd party companies.1. All information that you are required to provide with this Health Questionnaire, as well as any other medical information thereafter, is required to be truthful, complete, and accurate. If it is not accurate, the surgeon can cancel your surgery resulting in the loss of security deposit and all monies paid for the surgery.2. It is imperative that the height and weight reported on the Health Questionnaire be accurate. ALL patients are weighed and measured before surgery. If the BMI (Body Mass Index) at the time of surgery does not accurately reflect the height and weight reported on the Health Questionnaire, the surgeon(s) may exercise their right to forego the surgical procedure and any deposit made will be forfeited.3. If you decide to schedule your surgery, we reserve the right to be able to contact you via phone, email, whatsapp, and/or text. Any previous settings for those communication methods to be disabled will be overridden.Your information is not shared or sold. Your health information is kept private only to be seen by International Metabolic Bariatric Center SC and necessary parties involved.Deposit, Refund, & Cancellation Policy (If Surgery is Scheduled)International Metabolic Bariatric Center SC® (IMBC) posts its deposit, refund, and cancellation policy that is documented on the Health Questionnaire (HQ) and the Consent Form. This policy applies to all surgeons and surgery types offered through International Metabolic Bariatric Center SC. Please contact your patient coordinator if you have any questions regarding these policies.Deposit and Booking Bariatric Surgery1) Security Deposit: A deposit of $500.00 non-refundable (U.S. dollars) must be made on the day of scheduling your surgery. If you deposit via wire transfer or direct deposit, please email or fax a copy of the wire transfer or the direct deposit receipt with your name on it to 844-200-1939 to ensure proper credit. Deposit $500 USD is non-refundable. 2) Remaining Balance Deposit: The client is required to pay the entire remaining balance of the surgery (and send proof of payment) prior to surgery. Clients are required to have a zero balance before entering to surgery. If canceling or postponing the surgery, the remaining balance deposit will be governed by our refund and cancellation policy (found below). Surgery will be canceled/postponed until full payment of surgery is credited to our account. Any cost incurred by the client due to late payment and processing times, such as extra hotel nights, flight cancellation, or rescheduling, will be the sole responsibility of the client. Refunds and Cancellation Policy Due to the preparation costs (i.e., transportation reservations, hotel reservations, coordination time, administration, marketing, nutritional consultation, hospital space, scheduling of hospital staff, surgical team timeslots, supplies ordered according to the surgery program, etc.), all refunds will be handled based on the following criteria: Before Travel1) If the client cancels 46 DAYS or more before the ORIGINAL surgery date, then a full refund of the $500 deposit plus any additional payment(s) will be provided minus any miscellaneous costs incurred by International Metabolic Bariatric Center SC, including but not limited to transportation, hotel accommodations, pre-op test(s), doctor fees, companion fees, Medical Tourism Insurance (MTI), processing fee ($45.00), nutritional consultation ($175.00), etc. 2) If the client cancels within 31 to 45 DAYS before the ORIGINAL surgery date, then a 60% refund of the $500 deposit plus any additional payment(s) will be provided minus any miscellaneous costs incurred by International Metabolic Bariatric Center SC, including but not limited to transportation, hotel accommodations, pre-op test(s), doctor fees, companion fees, Medical Tourism Insurance (MTI), processing fee ($45.00), nutritional consultation ($175.00), etc. 3) If the client cancels within 30 DAYS of the ORIGINAL surgery date, the $500 deposit will be forfeited. 4) If the client cancels within 15 DAYS or less before the ORIGINAL surgery date, the client is responsible for paying 35% of the total package cost. If the client opted-in for Medical Tourism Insurance (MTI) coverage, it will be forfeited (non-transferable and non-refundable). 5) If surgery is RESCHEDULED (R/S), all cancellation rules and policies apply to the ORIGINALLY scheduled date. If surgery is rescheduled within 15 DAYS of surgery, ALL deposits will be forfeited. After Travel1) If surgery is CANCELED for reasons such as no show, noncompliant with the pre-operative instructions, incomplete documentation, financing issues, rule-breaking, cold feet, etc., 35% of the total package cost will be refunded minus any miscellaneous costs incurred by International Metabolic Bariatric Center SC, including but not limited to transportation, hotel accommodations, pre-op test(s), doctor fees, companion fees, Medical Tourism Insurance, processing fee ($45.00), nutritional consultation ($175.00), etc.2) If surgery is CANCELED/POSTPONED due to medical conditions discovered during the pre-operative tests or if it is determined that the operation cannot proceed due to safety reasons, 35% of the total package cost will be refunded minus any miscellaneous costs incurred by International Metabolic Bariatric Center SC, including but not limited to transportation, hotel accommodations, pre-op test(s), doctor fees, companion fees, Medical Tourism Insurance, processing fee ($45.00), nutritional consultation ($175.00), etc.3) If the procedure was not completed and the surgical team determined the operation could not be performed safely, there will be NO REFUNDS. Miscellaneous Rules- All cancellations must be received by International Metabolic Bariatric Center SC in writing, via email, fax, or online.- Please allow ~8 to 12 weeks for processing refunds.- If collections are necessary, the cost/fees incurred by International Metabolic Bariatric Center SC will be applied to your balance owed.- If the client reschedules more than once, a $500 USD penalty will be applied to the balance.- If the client reschedules less than 2 weeks before surgery, the client will lose your discounted rate from the original pricing, and any deposit paid will be forfeited.- I understand I am responsible for any fees my credit card provider may charge for card usage outside the U.S.- 15 days advance notice is required for cancellation of the hotel to be eligible for a refund.- Please find the link to the Official Cancellation Form.- Agreeing to the refund policy is bound by our most updated policy on our website at the time of cancellation.- International Metabolic Bariatric Center SC reserves the right to change our refund policy at any time *Last Updated: 02/07/2024 Additional Fees (If Applicable)I agree to the Additional Fees (if applicable). **These fees only pertain to certain patients. You have no obligation unless you decide to move forward with the process.**⮞ CT Scan - $150⮞ High BMI 49+ - $500⮞ High BMI 59+ - $1,000⮞ Extra Hotel Nights - $130⮞ Hiatal Hernia - $500⮞ Endoscopy - $700⮞ Extra Night Hospital - $500⮞ Gallbladder Removal - $500⮞ Revision charge $500* Prices subject to change without notice. Additional charges may also apply for patients with certain medical conditions, medications not included in standard post-op orders and/or for procedures not included in the initial surgical procedure (i.e.; Hiatal hernia repair etc.)All fees stated are in USD. A 16% additional fee is required for credit card payments. (Visa, MasterCard, American Express & Discover)