Notice of Privacy Practices & Financial Policies
Vinyard Institute of Plastic Surgery, LLC Updated 9.12.2022
Notice of Privacy Practices:
Our Notice of Privacy Practices (Notice) provides information about how we may use and disclose protected health information about you. You have the right to receive and review our Notice before signing this acknowledgment. As provided in our Notice, the terms of our Notice may change. If we change our Notice, you may obtain a revised copy.
By signing this form, you acknowledge that you have been informed of our uses and disclosures of your protected health information for all of the purposes set out in our Notice; you also acknowledge that a copy of our Notice is available to you under the Resources Tab on our website, www.plasticsurgeryvips.com, and is readily available at the patient concierge desk. You understand the contents of our Notice and how it applies to you, and that all your questions regarding the contents of our Notice have been answered to your satisfaction.
Thank you for choosing Vinyard Institute of Plastic Surgery, LLC. We are dedicated to providing you with outstanding care and service; as well as meeting your healthcare needs. Your understanding of our policies is an essential element of your care. Our goal is to keep your financial arrangements as simple as possible. If you have any questions regarding our policies, please feel free to present your questions to one of our VIPS team members.
Payments are due prior to services being rendered. Please be advised that it is the policy of Vinyard Institute of Plastic Surgery, LLC to collect payment in full prior to the time of service. We accept Visa, Mastercard, Discover, American Express, CareCredit, Alphaeon credit, PatientFi, money orders, cashier’s checks, personal checks or cash. Note: Please make all checks payable to Vinyard Institute of Plastic Surgery, LLC. There is a $50.00 charge for a returned check. Returned checks over $500.00 will be assessed a fee of 5% of the total amount of the check. We reserve the right to send all accounts with balances over 30 days old to an outside collection agency. All accounts sent to collections will be charged a $50.00 processing fee by Vinyard Institute of Plastic Surgery, LLC and any additional costs associated with any attorney fees, court costs, etc.
VIPS Cosmetic Surgery and In-Office Cosmetic Procedures:
There is a non-refundable and non-transferable Consultation Fee of $100 required to book a cosmetic consultation with Dr. Vinyard. This fee is collected upon booking and will be forfeited if the appointment is cancelled or rescheduled with less than (2) business days (M-F 9am-5pm) notice. The consultation fee compensates for the time and expertise provided to you by Dr. Vinyard. The fee may not be applied to any procedures, services, or products.
There is a $1,000 non-refundable and non-transferable Reservation Fee required at the time of reserving your procedure date. This fee is used to cover the time intensive booking and scheduling process involved in reserving a procedure date exclusively for you. This reservation fee will only be applied toward the procedure and scheduled procedure date for which the reservation fee was initially paid.
Procedure Balance Payment
You will be required to pay the remaining balance due for your scheduled procedure no later than three weeks prior to your procedure date. Note: Post-dated checks will not be accepted. If you plan to use a debit card for your final payment, it is recommended that you contact your bank in advance due to possible daily limit restrictions.
Rescheduling your procedure for any reason will require an additional $1,000 Reservation Fee for booking and scheduling a new procedure date.
If for any reason medical or personal, you cancel your procedure you will be charged as follows: 14 days prior=25% of the total procedure fee, 7-13 days prior=50% of the total procedure fee; 2-6 days prior=75% of the total procedure fee, 1 day prior=100% of the total procedure fee.
VIPS Cosmetic Center MedSpa Services:
Treatment Reservation Fee
There is a non-refundable and non-transferable Reservation Fee required to reserve your scheduled treatment with one of our providers. Please refer to your individualized treatment proposal for exact fees. This reservation fee will be collected at the time of booking.
Procedure Balance Payment
You will be required to pay the remaining balance prior to your scheduled treatment. We accept Visa, Mastercard, Discover, American Express, CareCredit, Alphaeon credit, PatientFi, money orders, cashier’s checks or cash for our MedSpa services. Personal checks will not be accepted for MedSpa treatments.
Rescheduling within (2) business days (M-F 9am-5pm) of your scheduled treatment will result in the loss of the initial reservation fee and will require an additional Reservation Fee to schedule a new procedure date.
The cancellation of any treatment appointment within (2) business days (M-F 9am-5pm) of your scheduled treatment will result in the loss of the initial reservation fee paid. Any subsequent treatment appointments will be subject to a new reservation fee.