I hereby authorize Look Beyond Beauty LLC to provide evaluation and treatment. I give permission for the release of medical information necessary to process insurance claims and understand that I am responsible for any charges not covered by my insurance plan. I consent to using and disclosing my health information for treatment, payment, and healthcare operations as outlined in the HIPAA policy.

By typing your name below, I am signing this form electronically.

Refund & Cancellation Policy

We kindly ask that you cancel or reschedule appointments at least 48 hours in advance.

• Cancellations made with less than 48 hours’ notice or no-shows may result in a non-refundable charge.

• Refunds are only issued for appointments canceled before the 48-hour window.

 
*By checking the box below and submitting this form, you acknowledge that you have read and agree to the terms of this policy.*

Review The Full HIPAA Privacy Notice Here:

 Click here to read our HIPAA Privacy Notice