This Patient Surgical Agreement – Terms and Conditions (the “Agreement”) is made and entered into between the Company identified on the Invoice signed by the Patient and the individual signing the Invoice (the “Patient”).
1. Contract purchase & Agreement.
This Agreement encompasses all the services listed on the Patient’s Invoice, as well as any subsequent Invoice(s) signed by the Patient. Furthermore, it includes any additional services that the Company reasonably deems necessary to provide in order to fulfill the services listed on the Invoice(s). These collectively constitute the “Services” covered by this Agreement.
2. Patient Financial Responsibility.
The patient acknowledges and agrees that they are solely and entirely responsible for the payment of all services rendered and any additional fees incurred as per the terms of this Agreement. The patient agrees to pay the full amount for the services received, including any additional fees imposed in accordance with the terms of this Agreement
3. Booking Fee; Time Frame.
3.A. In General. To schedule surgery with the Company, the patient is required to pay the Booking Fee specified on the patient’s Invoice. It is important to note that the Booking Fee is non-refundable. This fee encompasses all expenses, including administrative costs, associated with the necessary work carried out from the patient’s initial inquiry until the booking of the surgery. The initial fee remains valid for a duration of 12 months. However, if the initial fee is not utilized towards surgical services within this timeframe, the Booking Fee will be considered forfeited, and a new Booking Fee will be required. Additionally, if there are changes to the promotional pricing during the rescheduling period, additional costs may apply.
3.B. The patient recognizes that the Total Price is calculated based on their weight at the time of executing the Agreement. Unless advised by a medical professional from Goals or their representative to gain weight prior to the procedure, if the patient gains more than five (5) pounds between the Agreement date and the Procedure Date, Goals retains the right, before or on the Procedure Date, to
3. C Promotional prices may be subject to change without notice and restrictions may apply.
3.D.All medical consultations are conducted upon patient request. Please note that this appointment will incur an additional fee.
4. Contract Changes Resulting in Additional Fees to Patient.
a. Change of Surgeon. If the patient decides to change the surgeon listed on the Invoice and selects a surgeon who is less expensive than the initially chosen surgeon, a $500 change fee will apply. However, if the surgeon listed on the patient’s Invoice becomes unavailable or unable to perform the requested services, the Company retains the exclusive right to assign a different surgeon to carry out the services at no additional cost to the patient. Please note that any change of surgeon initiated by Goals does not entitle the patient to cancel or reschedule any of the services.
b. Change of Surgery Date. The patient has the option to reschedule their surgery without incurring any penalties if they provide at least 30 days’ notice prior to the initially scheduled surgery date. However, if the patient reschedules their surgical procedure within 30 days of the original surgery date, they understand and agree to be subject to an additional $500 rescheduling fee. It is important to note that if a conflict or any other unforeseen circumstance arises on Goal’s end regarding the patient’s surgery date, the Company reserves the exclusive right to change the surgery date at no additional cost to the patient. Goals will make reasonable efforts to minimize any changes to the patient’s surgery date. Please be aware that any changes to the surgery date initiated by Goals will not serve as a basis for the patient to cancel or reschedule any of the services.
c. Change of Services or Surgical Plan. The surgeon has the sole and exclusive discretion to modify the areas to be treated. Based on their medical expertise, the surgeon may make changes to the surgical plan to ensure the best outcome for the patient. If the surgeon determines it necessary, they reserve the right to cancel the procedure or divide it into multiple rounds, taking into consideration the patient’s weight or body structure.
d. Cancellation. The patient has the option to cancel their surgery without incurring any penalties if they provide at least 30 days’ notice prior to the initially scheduled surgery date. However, if the patient cancels their surgical procedure within 30 days of the original surgery date, they understand and agree to be subject to an additional $500 cancellation fee.
5. Problems and Complications Resulting in Additional Fees to Patient.
5.1. The patient acknowledges and agrees that complications or issues before or during surgery may lead to additional fees and expenses that will be charged to the patient. These costs may include supplementary anesthesia and facility fees, hospital expenses, physician and surgeon fees, or other related charges. The patient bears sole responsibility for these fees and costs.
6. Payment Options.
a. Direct Payments. The company accepts payments in cash (U.S. Dollars) as well as the following credit cards: Visa, MasterCard, and Discover. However, please note that personal, business, or cashier’s checks are not accepted by GOALS PLASTIC SURGERY. Additionally, all payments made have to be by the authorized cardholder. If the payment is made on behalf of the patient, that third party must provide Government-issued identification. It is important for patients to comply with these payment requirements. Failure to do so will result in the immediate cancellation of the scheduled surgery, and the non-refundable booking fee paid by the patient will be deemed forfeited.
b. Payments Through Third-Party Lenders. Payment Terms: The company has specific requirements for payments made through finance companies. Such payments must be made no earlier than 2 weeks prior to the scheduled surgery date and no later than 5 days prior to the surgery date. In order for the company to accept financing payments, the patient is required to submit a legible copy of valid government-issued identification, as per the company’s instructions. Additionally, the patient must be an authorized cardholder. If a third party is making the payment on behalf of the patient, that third party must provide both a government-issued identification and a credit card that matches the name on the identification document. Failure to comply with these requirements will lead to the immediate cancellation of the scheduled surgery, and the non-refundable booking fee paid by the patient will be considered forfeited.
c. Cash-Only Discount. Patients who express interest in our cash-only discount will be eligible to receive a discount once the full balance payment, including the initial fee, is received in cash.
d. Forfeiture of Monies. If Patient fails to undergo the surgical procedure stated in Patient’s Invoice within twelve (12) months from the date of payment of the Booking Fee, then ALL monies paid to Company shall be deemed forfeited by Patient and Company shall be entitled to retain ALL monies paid by Patient without any refund to Patient.
e.Deadline for Payment in Full. A payment equivalent to fifty percent (50%) of the Total Price of the Procedure must be made at least one (1) month prior to the scheduled Procedure Date. Failure to fulfill this payment requirement will result in the cancellation of the Procedure, necessitating the need for rescheduling as outlined in the terms and conditions provided. It is important to note that this cancellation will be considered as initiated by the Patient, as per (Section 6. b) of this Agreement since it is a direct consequence of the Patient’s own actions.
The outstanding balance of the total cost of the Procedure must be paid in full at least Fourteen (14) Days prior to the Procedure Date, and all required blood/lab work must be submitted to Goals no later than Thirty (30) days prior to the Procedure Date. Failure to meet these payment and submission deadlines will result in the cancellation of the Procedure and the removal of the Patient from the surgical calendar unless rescheduled in accordance with the terms outlined herein. It is important to note that this cancellation will be considered as initiated by the Patient, as it is a direct consequence of their own actions
f. The Patient acknowledges that in the event of a dispute concerning any charges made by the Patient or the cardholder with a credit card or financing company, where the charges correspond to the accurate amount determined by the Company’s records, the Company retains the right to cancel all Services, revoke all scheduled appointments, and consider any payments made by the Patient as forfeited. If, at the discretion of the Company, services are to be continued for the Patient, all future payments must be made exclusively in cash, including a new cash-only Booking Fee
g. Required Government Issued Identification. In situations where the Company requires identification from the Patient, it is necessary to provide a government-issued identification that meets the following criteria: it must include a current photograph and must not be expired. The Company accepts the following forms of identification: (1) State-issued Driver’s License, (2) State-issued Non-Driver ID, (3) Government-issued passport, (4) Military identification, or (5) Government-issued Green Card/Resident Alien Card.
7. Pre-Surgical Laboratory Testing & Medical Clearances.
- The Patient is required to submit their bloodwork and medical clearance no later than 3 days prior to the scheduled surgical date. However, in the event that the Patient’s procedure is scheduled within a time frame of less than 30 days but more than 14 days prior to the surgery, the Patient must submit their bloodwork and medical clearance no later than 10 days prior to the surgical procedure. If the Patient’s procedure is scheduled within less than 10 days, the Patient must expedite the results to Goals no less than 3 days prior to the surgery. Any additional testing, clearances, or studies requested by the surgeon must be submitted to the Company by the deadline specified to the Patient, such as the lab’s department. Please note that the due dates are subject to change by the Company. Failure to provide the requested laboratory results, clearances, or studies by the stated deadlines will result in the cancellation of the Patient’s surgery without any refund of the Booking Fee. It is the sole responsibility of the Patient to obtain and cover the costs associated with their medical clearances, laboratory testing, and any other studies, tests, or results requested by the Company and/or the surgeon.
8. Pre-Surgical Requirements; Circumstances Resulting in Cancellation of Surgery; Additional Fees.
a.For surgeries that include a Tummy Tuck/Abdominoplasty and FlexSculpt® 360, it is mandatory for the Patient to have a Body Mass Index (“BMI”) of 31 or lower on the day of their pre-operative appointment. For surgeries that do not include a Tummy Tuck/Abdominoplasty, the Patient must have a BMI of 60 or lower on the day of their Surgical procedure.
b.Pregnancy Prior to Surgery. The patient is strictly prohibited from undergoing surgery if they are pregnant. Furthermore, if the Patient receives a diagnosis of pregnancy resulting in a failed pregnancy, miscarriage, or termination within 6 months of the scheduled surgery date, it is necessary to reschedule the surgery within an appropriate time frame. Additionally, the Patient agrees to undergo a pregnancy test administered by the Company on the day of the surgery, prior to the commencement of the procedure. If the pregnancy test yields a positive result, the Patient’s surgery will be immediately canceled. In the event of a cancellation on the day of surgery due to a positive pregnancy test, the Patient will be responsible for a cancellation fee of $500 in addition to the Non-Refundable Booking Fee. However, if the Patient chooses to reschedule the surgical procedure instead of seeking a refund, the Company may consider waiving the cancellation fee and any new Booking Fee as a one-time courtesy. Additionally, the Company may grant the Patient a one-time courtesy 18-month contract extension to allow for rescheduling of the surgical procedure.
c. If a Patient’s hemoglobin level, as indicated by the laboratory results submitted to the Company within the specified timeframe, is below 10.0, the Patient’s surgery will be postponed. The Patient may have the option to reschedule the surgery within the timeframe outlined in Section 3 of this Agreement, subject to possible additional fees.
Furthermore, the Patient’s A1C level, as determined by the laboratory results submitted to the Company within the required timeframe, must not exceed 7.4. If the A1C level surpasses this threshold, the Patient’s surgery will be postponed. The Patient may then have the opportunity to reschedule the surgery within the timeframe specified in Section 3 of this Agreement, subject to potential additional fees.
d. Medications for Pre-Existing Conditions. In the event that a Patient has been diagnosed with a pre-existing medical condition that can be regulated or controlled, it is mandatory for the Patient to seek additional treatment from their primary doctor in order to effectively manage the condition. This may involve following a prescribed medication regimen. It is crucial that the condition is properly controlled before scheduling or rescheduling any Services for the Patient.
e. Nicotine Test. The patient agrees to have a nicotine test administered by Goals on the day of surgery prior to the start of the procedure. If the test results are positive, the Patient’s surgery will be immediately canceled, and all payments made to Goals shall be deemed forfeited without any refund to the Patient. At the medical discretion of the physician, exceptions to this baseline requirement may be considered. However, if the Patient decides to reschedule the services, an additional rescheduling fee of $1500.00 will be required, and the previously paid amount to Goals will be applied toward the services.
9. Misrepresentation or Forgery of Medical Information.
If the Patient intentionally provides false or forged medical information or medical records, including but not limited to medical clearances or laboratory results, as determined by Goals, all payments made by the Patient to Goals will be forfeited, and the Patient will be prohibited from receiving any services from Goals.
10. Post-operative Visits.
Goals recommend that patients attend the following post-operative appointments after any cutting procedure, with the surgeon who performed the Services, at the designated location: (i) The first postoperative visit should take place within one week of the surgery. Goals provide these post-operative visits with the surgeon at no additional cost. For any additional postoperative visits with the surgeon, patients will be charged a fee of $250 per visit. However, in the event of a medical complication, patients may attend additional follow-up visits with the surgeon, free of charge, subject to the surgeon’s discretion and authorization.
11. Caretaker Policy
patient acknowledges the responsibility of arranging for a legal adult caretaker (18 years or older) to pick them up after their surgical procedure. Patients are required to provide the name and information of the designated caretaker to Goals prior to the surgery. It is strictly prohibited for a ride-share service or taxi to be considered as a suitable caretaker. Patients understand that the effects of anesthesia and surgery necessitate the presence of a competent caretaker, and this policy is mandatory to ensure the safety of the Patient. Goals will notify the designated caretaker when the surgery is completed, and the caretaker must collect the Patient within one hour after the surgery. If the designated caretaker fails to promptly pick up the Patient within the specified one-hour window, Goals reserves the right to call an ambulance or emergency medical services to transport the Patient, and the associated costs will be the sole responsibility of the Patient.
12. Recovery Period After Surgery.
Patients are required to stay within a 20-mile radius of the surgery location for a minimum of five (5) days following the surgical procedure in order to receive necessary post-operative care. Failure to comply with this requirement will be considered as leaving against medical advice.
13. Additional Non-Surgical Services.
a. Post-surgical or lymphatic massages may be offered to patients as an option for faster recovery after the surgery. It is important to note that these massages are specifically designed for post-operative purposes and will only last for a duration of 30 minutes. Please be aware that all messages purchased are non-refundable.
b. Surgical Accessories. Surgical accessories or aesthetic services are non-refundable and non-transferable. This means that once purchased, these items or services cannot be refunded or transferred to another person.
14. Touch-Up Policy
14.1. In General. In general, all plastic surgery treatments and operations aim to improve unsatisfactory areas of the patient’s body with a high probability of success. It is important for the patient to understand that the outcome of the procedure depends on various factors, some of which are beyond the control of the company. It is crucial for the patient to have realistic expectations regarding the potential results based on their body type, medical history, and other factors within their control.
While the company understands that not all patients may achieve their desired results, there are cases where the surgeon, at their sole discretion, may offer a touch-up procedure within one year from the date of the original surgery. The fees and costs associated with the touch-up procedure will apply as specified in the agreement. However, if the surgeon who performed the original surgery is no longer employed by the company at the time of the touch-up procedure, the patient will not be eligible to receive it.
If the patient is not satisfied with the initial results, Goals Aesthetics & Plastic Surgery® ( Doctor & Management) may, at its sole discretion, agree to revise or touch up the patient’s results at a reduced fee of $2000-$3500. This fee covers anesthesia, operating room, nursing fees, ‘before and after’ photographs, and other associated costs. These terms are only limited to minor touch-ups. However, the following conditions must be met
i. It has been at least sixteen (16) weeks (approximately four (4) months) but no more than one (1) year since the Procedure Date.
ii. The patient’s weight has remained the same since the Procedure Date, with no more than a 2% deviation in BMI.
iii. The patient has not been pregnant or given birth since the Procedure Date.
iv. The patient has not smoked or used any tobacco products since the Procedure Date.
v. The patient has followed all the post-operative instructions in the Patient Information Booklet, including:
A. Wearing all required compression garments for the prescribed duration.
B. Receiving at least 10 postoperative massages from Goals or an authorized and/or approved satellite or third-party location.
C. Attending all required post-operative follow-up appointments and messages.
D. Following all other post-operative instructions in the Patient Information Booklet.
vi. The touch-up is not a request for additional fat removal/liposuction or fat injections in any area not treated with autologous fat transfer in the original procedure.
vii. The touch-up is specifically for the problem area that was treated in the original procedure.
It’s important to note that revisions may be considered new procedures and are sometimes intended solely to correct minor issues that naturally arise from the initial procedure, such as concave areas or small bulges.
15. No Warranty.
The patient recognizes that the practice of medicine and surgery is not an exact science and understands and accepts that fees are paid for the performance of the Services only, and NOT A GUARANTEED RESULT. The patient acknowledges that although a good outcome is expected, and a reasonable effort has been made to establish realistic expectations, the COMPANY DOES NOT GIVE ANY WARRANTY, EXPRESSED OR IMPLIED, AS TO THE RESULTS THAT MAY BE OBTAINED.
16. Cancellation & Refund Policy; Exceptions.
a.. Goals understands that situations arise that may force patients to postpone Patient Services. Patients must understand that such changes affect the surgeon, operating room staff, Company staff, and other patients. The surgeon’s time, as well as that of the operating room staff, is precious and the Company requests the Patient’s courtesy and concern.
b. Policies. The following are the Company’s cancellation and refund policies, which are subject to the terms and conditions as set forth in this Agreement:
Cancellation for Medical Necessity: a. Patients may cancel their Procedure(s) if there is an untreatable medical reason that prevents the procedure from taking place. A licensed physician must provide a medical note directing the cancellation and explaining the specific revocation of medical clearance, including the full diagnosis and prognosis. Revocation of medical clearance due to specific medical conditions must be provided by a specialist in the relevant field, and the document must detail why clearance is revoked. In this case, if a compliant document is provided, the full amount paid toward the Total Price will be refunded, except for the Initial Fee. Amounts paid toward Laboratory Fees/Blood Work, Accessories, and Compression Garments will not be refunded. The approval of any refunds is at the sole discretion of Goals.
Any refund requested by the patient shall be subject to the understanding that a FULL refund for the surgical procedure they contracted for shall not be provided. Fees shall be deducted from the funds already paid, including the (Local Anesthesia) $2500 hold fee and the corresponding initial fee, as well as the (General Anesthesia) $3000 fold fee and its corresponding initial fee, ALL OF WHICH SHALL NOT BE REFUNDED TO THE PATIENT.
b. Goals Aesthetics and Plastic Surgery may reschedule the Procedure if the assigned doctor is unable to perform it on the Procedure Date as specified in Section 4 above. If the Patient refuses to have their procedure rescheduled, the Initial Fee and any paid Interim Payment Amount(s) are non-refundable, and the provisions of Subsection 4 below will apply.
c. If the Patient fails to disclose any pre-existing or current health conditions that prevent Goals from proceeding with the surgery or treatment, it will be considered a cancellation by the Patient, in accordance with Subsection 5(e) below.
d. When the Patient reserves a procedure date, Goals rely on the Patient’s presence and do not book other patients for that same date and time. Goals also invest significant time, effort, and resources in preparing for the surgery. Therefore, if the Patient cancels for any reason other than those outlined in Section 4, it will be deemed a cancellation without reason, subject to the terms of Section 5(e) below.
e. If the Patient cancels their Procedure for any reason other than medical necessity, the Patient will forfeit all fees paid toward the Procedure as of the cancellation date, including the Initial Fee, all Interim Amounts, and amounts paid toward Laboratory Fees/Bloodwork, Accessories, and Compression Garments. This forfeiture is intended to compensate Goals for the work done and the lost income resulting from the Patient’s breach of the agreement. The Patient acknowledges that this forfeiture is not a punishment but a form of compensation. Any litigation arising from the Patient’s breach of this agreement shall be dismissed based on the terms herein.
f. Any cancellations must be made by the Patient directly to Goals, and not to any other entities or financing companies. The Patient shall not request a chargeback or refund from any financing agency. Violation of this agreement by seeking a refund from a financing company constitutes a material breach. The Patient understands that a copy of this agreement will be submitted to any financing company in the event of a violation, and any chargeback request shall be denied. Furthermore, if the procedure is performed and the Patient later seeks a chargeback, the Patient agrees to be liable for compensatory damages incurred by Goals in seeking payment, including all legal fees and litigation costs.
Please note that this is a retyped version and may not include all the nuances and legal implications of the original document. It is advisable to consult with a legal professional for specific legal advice and interpretation.
21.3. Exceptions. To follow are the exceptions to the Company’s cancellation and refund policies, as set forth in this Agreement:
- In the event that the Patient fails to meet the necessary requirements to proceed with the surgery and this failure is directly attributed to the recent death (occurred within the past 7 days) of an immediate family member (i.e., mother, father, brother, or sister), the Patient must inform the Company and provide a copy of the Death Certificate. By doing so, the Patient can prevent any forfeiture of funds or the imposition of additional fees for rescheduling or cancellation
- Similarly, if the Patient fails to meet the necessary requirements to proceed with the surgery due to being deployed by any branch of the United States military, the Patient must disclose this information to the Company and provide official and appropriate documentation confirming their deployment. By complying with these requirements, the Patient can avoid any forfeiture of funds or the imposition of additional fees for rescheduling or cancellation.
21.4. Time Frame for Issuance of Refund. Processing eligible refunds may take 45 days or more to be issued.
a. SEVERABILITY: If any provision of this Agreement, or its enforcement, is determined by an arbitrator or a court of competent jurisdiction to be invalid, unenforceable, or illegal, in whole or in part, it shall not affect the validity and enforceability of the remaining provisions of this Agreement.
b. SURVIVAL: The representations, warranties, and covenants stated in this Agreement, as well as those in any other document delivered under this Agreement, shall remain in effect even after the execution of this Agreement.
c. ENTIRE AGREEMENT/AMENDMENTS: This Agreement constitutes the entire agreement between the Parties concerning the matters referred to herein. There are no other promises, inducements, representations, warranties, understandings, undertakings, or agreements, oral or written, express or implied, between or among the Parties, except as specifically outlined in this Agreement.
This Agreement may only be altered, amended, canceled, revoked, or modified by a written agreement subscribed to by all Parties affected by such changes.
d. HEADINGS AND SYNTAX: The headings in this Agreement are included for convenience and reference purposes only and do not alter, limit, expand, describe, or impact the content, scope, or intent of this Agreement. References and pronouns used in this Agreement shall be construed in the singular or plural form and in the appropriate gender based on common sense and circumstances.
e. GOVERNING LAW: This Agreement, along with any other referenced documents, shall be governed by, interpreted, and enforced in accordance with the laws of the State of Florida, without considering conflicts of laws principles.
f. FURTHER ASSURANCES: The Parties agree to execute any additional documents and undertake any other necessary actions reasonably required to fulfill the objectives of this Agreement.
17. Lateness Policy:
The Patient must arrive at the office on the Procedure Date at least one (1) hour prior to the scheduled time for the Procedure. Failure to arrive on time will result in a late fee of $250.00 for every fifteen (15) minutes of delay, as it disrupts the scheduling for both the Patient and other patients, as well as the surgeons. All late fees must be paid in full, or the procedure will be canceled. Failure to pay the late fees will be treated as a cancellation by the Patient, as stated in Section 5(e) above.
18. State Specific Rules for Liposuction:
The maximum amount of fat that can be removed during a liposuction procedure is determined by multiple factors, including state regulations. Currently, in Florida, the limit is set at 4,000 cc of fat for a single procedure. Goals will not exceed this limit. However, based on the surgeon’s professional judgment, a lower amount may be removed to ensure Patient safety while still achieving the desired results. Patient safety is the utmost priority for Goal and its doctors/surgeons.
19. Loose/Excess Skin
Liposuction solely targets the removal of subcutaneous fat, not skin. After the procedure, the skin over the treated areas may become loose and may or may not regain elasticity without further intervention, including surgical procedures. The Patient acknowledges and understands that additional procedures may be necessary to address loose skin, which is not included in the price of the liposuction procedure.
20. Limitation of Liability.
The company is not liable for Patient’s traveling expenses under any circumstances.
ADDITIONALLY, IN NO EVENT SHALL THE COMPANY BE LIABLE TO PATIENT OR ANY THIRD PARTY FOR ANY GENERAL, SPECIAL, INDIRECT, INCIDENTAL OR CONSEQUENTIAL DAMAGES (INCLUDING, WITHOUT LIMITATION, INDIRECT, SPECIAL, PUNITIVE, OR EXEMPLARY DAMAGES FOR LOSS OF BUSINESS, LOSS OF PROFITS, OR BUSINESS INTERRUPTION) ARISING OUT OF OR CONNECTED IN ANY WAY WITH THIS AGREEMENT, PATIENT’S SERVICES, PATIENT’S INVOICE(S), PATIENT’S RELATIONSHIP WITH THE COMPANY AND/OR ANY SERVICES RENDERED BY THE COMPANY. THE TOTAL LIABILITY OF THE COMPANY TO THE PATIENT FOR ALL DAMAGES, LOSSES, AND CAUSES OF ACTION (WHETHER IN CONTRACT, TORT (INCLUDING BUT NOT LIMITED TO NEGLIGENCE), OR OTHERWISE) SHALL NOT EXCEED THE TOTAL FEES PAID BY PATIENT DURING THE TWELVE (12) MONTHS IMMEDIATELY PRECEDING THE EVENT GIVING RISE TO LIABILITY, EXCLUDING THE BOOKING FEE.