By signing the contract provided to you, and to which these terms and conditions are identified and incorporated into by reference (hereafter the “Agreement”), the Patient agrees to the following:
1. Cost of Procedure. The Total Price for the Agreement is as set forth thereupon as the “Balance.” The Balance is the total amount that is paid for the procedure itself, all post-operative packages, any processing fee(s), the costs for anesthesia (if any), the cost for garment(s) (if any), and the cost for any materials purchased. This amount, the Total Price must be paid in full prior to the procedure taking place. The Total Price includes a processing fee of Five Hundred Dollars ($500.00) which is not a deposit and is for services provided at the time of executing the Agreement which include payment to the patient coordinators for processing your agreement and discussing the process, initial consultations with Goal’s staff who are in contact with medical professionals related to the patient’s initial scheduling, scheduling of the procedure, purchasing of materials and consumables, scheduling anesthesia, and other expenses. As discussed below, this is a non-refundable amount for services provided. Further, the Total Price is subject to the following conditions:
a. The Patient acknowledges that the Total Price is calculated based upon the Patient’s weight on the date of the execution of the Agreement. Unless the Patient has been advised by a medical professional from Goals®, or their agent, to gain weight before the procedure, if the Patient gains more than five (5) pounds between the date of the Agreement and the Procedure Date, then, on or before the Procedure Date, Goals® reserves the right to:
i. Modify the areas to be treated if, in the performing surgeon’s sole and exclusive discretion, the surgeon believes that the planned areas would result in surgery which exceeds what the medical professional deems, in their professional opinion, to be safe and not excessive at the time and for a single procedure;
ii. Cancel the procedure if, in the if in the surgeon’s sole and exclusive discretion, the surgeon believes that the planned areas would result in surgery which exceeds the surgeon’s professional opinion as to being safe and not excessive at the time for a single procedure and it would be medically unsound to proceed; or
iii. Cancel the Procedure unless an additional fee is paid. Such additional fee will be calculated based on the Patient’s BMI on the Procedure Date. Any such additional fee must be paid immediately and before any surgery is performed. Since this cancellation is a direct result of Patient’s own actions, failure to pay this additional cost will be treated as a cancellation by the Patient, in accordance with Section 5(e) herein.
b. Promotional prices may be subject to change without notice and restrictions apply. Any such promotions shall be identified on the Agreement and such terms and conditions shall be incorporated into the Agreement and Patient shall be bound by such terms and conditions.
c. The Total Price only includes those costs as set forth herein. There may be additional fees and costs which may be applicable. Such may include sales tax for items/garments purchased or other expenses such as costs for other medical providers or prescription medication prescribed to you by Goals® or another doctor. These expenses are not included in the Total Cost and shall be the Patient’s sole responsibility to pay.
d. Medical consultations with surgeons prior to the procedure are deemed separate medical appointments and are subject to a consultation fee to be paid. Notwithstanding, should a consultation be requested, it shall be provided.
e. If the Total Cost is not paid in full on the date of the Agreement, then the Patient may partake in the In Office Payment Plan as set forth in Section 2 herein.
2. In Office Payment Plan. Goals® offers a payment plan for patients who are unable to pay the entire cost for the procedure at the time of signing the Agreement. It is as follows:
a. The Patient is solely and ultimately responsible for the Total Price, as well as any other associated costs (e.g.: sales tax, blood work, medical clearance, medications, etc.) and Goals® reserves the right to collect the same from the Patient not withstanding any private or third-party financing to which the Patient may have obtained.
b. The Initial Fee ($500 Processing Fee) and all Interim Payments may be paid by cash or with credit card. Goals® does not accept personal checks.
c. The Initial Fee ($500 Processing Fee) must be paid on the day this Agreement is signed. The Total Price will not be held, and no Procedure Date will be assigned unless and until the Initial Fee is paid. The initial fee is NOT a deposit and is paid by the Patient to cover the initial costs of the procedure including, but not limited to, materials, disposable/consumable items, payment for scheduling of anesthesia, and the payment for the initial consultation. Notwithstanding anything to the contrary, in no event shall the initial fee be returned to the Patient nor transfer to a third party, or transfer for another service, as this amount represents costs already expended by Goals® in furtherance of the Patient’s scheduling and procedure(s). The Initial Fee is valid for up to One (1) Year. If the Patient fails to make any further payments within the One (1) Year period, then the Patient will be required to pay a second fee as such costs will have to be repeated.
d. Patient will be required to complete an Authorization for Recurring Credit Card Payments, the form of which is attached to the Agreement, and hereby incorporated by reference even if Patient agrees and/or intends to make payment(s) by cash.
i. The Patient agrees to be charged each Interim Amount on the respective Due Date.
ii. If any information on the Authorization for Recurring Credit Card Payments form changes before the Total Price is paid in full, it is the Patient’s responsibility to notify Goals® before the next Interim Payment Due Date.
iii. If Patient wishes to pay an Interim Payment in cash, instead of by credit card, Patient may do so by visiting the office on or before the respective Interim Payment Due Date, otherwise the credit card on file will be charged.
iv. All Interim Payment Amounts must be paid by the respective Due Date, otherwise the Procedure will be canceled. Since this cancellation is a direct result of Patient’s own actions, this cancellation will be treated as a cancellation by the Patient, in accordance with Section 5(e) of this Agreement.
e. Fifty percent (50%) of the Total Price of the Procedure must be paid at least one (1) month prior to the Procedure Date, otherwise the Procedure will be cancelled and need to be rescheduled pursuant to the terms herein. Since this cancellation is a direct result of Patient’s own actions, unless rescheduled pursuant to the terms herein, such cancellation will be treated as a cancellation by the Patient, in accordance with Section 5(e) of this Agreement.
f. The Total Price of the Procedure must be paid in full Fourteen (14) Days and all blood/lab work submitted to Goals® Thirty (30) days prior to the Procedure Date, otherwise the Procedure will be cancelled, and the Patient will be removed from the surgical calendar, unless rescheduled pursuant to the terms herein. Since this cancellation is a direct result of Patient’s own actions, this cancellation will be treated as a cancellation by the Patient, in accordance with Section 5(e) of this Agreement.
g. Should Patient fail to comply with the payment terms herein, and in lieu of a cancellation, the Patient may reschedule their appointment upon payment of a rescheduling fee of $500.00 pursuant to section 4(B) below.
3. Payments and Patient Financing:
a. If the Patient is not eligible or wishes not to partake in the In-Office Payment Plan set forth in Section 2 herein, the Total Price, along with all associated in-office fees (e.g.: sales tax, medical clearance, etc.), must be paid on the date that the Agreement is executed. This payment may be paid in cash (in office only) or by credit card. In order to pay by credit card, the Patient must complete a Credit Card Authorization Form, which shall be provided to the Patient, and, in such case, it is executed, the terms of which shall be incorporated by reference.
b. The Patient is responsible for the entire Total Price of the procedure, as well as any other associated costs (e.g.: sales tax, blood work, medical clearance, medications, etc.) and Goals® reserves the right to collect the same from the Patient.
c. At the current time, in addition to accepting cash and credit cards, Goals® offers financing through Third Party Lenders (“Financing Company” or “Financing Companies” as applicable). If Patient finances their procedures through any such Financing Company, then Patient must be approved for financing by such Financing Company before this Agreement is signed. Patient must ensure that Goals® receives payment, in full, from the Financing Company at least fourteen days prior to the Procedure Date otherwise the Procedure will be cancelled. Since this cancellation is a direct result of Patient’s own actions, this cancellation will be treated as a cancellation by the Patient, in accordance with Section 5(e) of this Agreement.
i. Patient understands that Goals® is neither affiliated with, or has any control over the decision making, of any Financing Company and, therefore, should credit be denied or payment not made by any Financing Company, Patient’s sole and exclusive remedy is against such Financing Company.
ii. Similarly, by entering into this Agreement, should any dispute arise with respect to financing through a Financing Company, then the Patient understands and agrees that, in no event, shall it bring any action against Goals® or any affiliate, doctor, medical practice, or any staff of Goals®, in any court or adjudicative body, including any arbitration, arising out of any financing, denial of financing, failure of the financing company to promptly pay Goals®, or any conduct from said financing company related to such financing, such as alleged violations of the Fair Debt Consumer Protection Act or any other cause of action whether statutory or based in common law.
iii. If Patient does file an action Goals® arising out of any allegations related to financing from a Financing Company, Patient understands that the Court must dismiss any such claim and, in the even that any claim is dismissed as for violating this cause, then Goals® shall be awarded its reasonable counsel fees and costs related to defending against such action and that Patient will be entirely and 100% responsible to reimburse Goals® for any such reasonable attorney’s fees and costs with such award of counsel fees and costs being made by the Court as a judgment of counsel fees and costs.
4. Rescheduling Policy. Goals® shall endeavor to schedule your appointment as close to the preliminary surgical date on the Agreement as possible. However, the final date of scheduling the Procedure shall be due to a number of factors such as facility and staff availability, doctor/surgeon’s availability and health, and the prompt payment of all payments required to be paid to Goals® for the procedure. Therefore, upon being provided with the Procedure date, the Patient must advise promptly (within 24 hours) to confirm or reschedule. If the Patient fails to request a new procedure date within 24 hours, then the following shall apply:
a. If the Patient requests a new date for the Procedure, after the initial 24-hour period, then such Procedure Date may only be rescheduled on no less than fourteen (14) days prior to the scheduled Procedure Date. Goals® cannot guarantee that a prompt new Procedure Date will be provided.
b.Any rescheduling of the procedure, after the initial 24-hour period, shall be done only upon the payment of a Five Hundred Dollar ($500.00) Rescheduling Fee as liquidated damages. Such Rescheduling Fee shall be paid before a new Procedure Date is provided or secured. Such is agreed to be a reasonable amount as a result of the loss that Goals® and/or its affiliated medical practices shall suffer as a result of the rescheduling as there can be no guarantee that a different patient will be able to take the scheduled surgical date for the Patient.
c. If the Patient requests to have the surgeon changed, then the Patient shall pay a Five Hundred Dollar ($500.00) Doctor Rescheduling Fee as liquidated damages. Such Doctor Rescheduling Fee shall be paid before a new Procedure Date is provided or secured. Such is agreed to be a reasonable amount as a result of the loss that any such surgeon shall suffer as a result of the rescheduling as there can be no guarantee that a different patient will be able to take the scheduled surgical date for the Patient.
d. A Procedure Date may not be rescheduled more than two (2) times, unless:
i. There is a medical reason for why the procedure cannot take place and a medical note from a licensed physician is provided to document the same reason which must also indicate that it was not a preexisting condition to which you were receiving treatment at the time of scheduling or that you had reason to believe that you may have been suffering from. Failure to disclose any pre-existing conditions not only jeopardizes your health but may cause complications from your Procedure. If the Patient was either under treatment for a pre-existing condition, or had reason to believe that you may have been suffering from such condition, and the Patient failed to disclose such condition, such shall be treated as a cancellation by the Patient, in accordance with Section 5(e) of these Terms and Conditions;
ii. The assigned doctor is unable to perform the rescheduled procedure; or
iii. An event of force majeure which shall mean that the Procedure cannot be performed because of the result of Acts of God (including fire, flood, earthquake, storm, hurricane, pandemic or other natural disaster), war, invasion, act of foreign enemies, hostilities (regardless of whether war is declared), civil war, rebellion, revolution, insurrection, military or usurped power or confiscation, terrorist activities, nationalization, government sanction, blockage, embargo, labor dispute, strike, lockout or interruption or failure of electricity or telephone service. If this occurs, there will be no cancellation or refund provided. The Procedure is to be rescheduled and rescheduled only.
iv. If the criteria provided above is not met, the Procedure Date will not be rescheduled for a third time and Patient will have been deemed to have canceled their Procedure. Since this cancellation is a direct result of Patient’s own actions, this cancellation will be treated as a cancellation by the Patient, in accordance with Section 5(e).
5. Cancellation Policy.
a. Cancellation for Medical Necessity. Patient may cancel their Procedure(s) if there is a medical reason for why the procedure cannot take place and a medical note from a licensed physician is provided directing that the procedure must be cancelled and providing a specific explanation why medical clearance is revoked including the full diagnosis and prognosis. Medical clearance revocation due to specific medical conditions shall be provided by a specialist in such field (e.g. from endocrinologist, cardiologist, etc. and not a general practitioner) and detail why clearance is revoked rather than a simple statement thereto. In this case and a proper document is provided compliant herewith, the full amount paid toward the Total Price will be refunded, EXCEPT, the Initial Fee, and any amounts paid toward Laboratory Fees/Blood Work, Accessories and Compression Garments will not be refunded. It will be at the sole and exclusive discretion of Goals® to approve any refunds.
b. Cancellation by Goals® Aesthetics and Plastic Surgery. If the assigned doctor is unable to perform the Procedure on the Procedure Date as set forth in Section 4 above, Goals® reserves the right to reschedule the Procedure. If the Patient refuses to have their procedure rescheduled, then, in such a case, the Initial Fee and any paid Interim Payment Amount(s) are not refundable and the provisions of Subsection 5(e) herein shall apply.
c. Cancellation by Goals® due to Patient Omissions. Patient has an absolute and non-waiverable obligation to advise Goals® of any and all pre-existing and current health conditions in order for Goals® to make a proper determination of candidacy for any desired procedures. If Patient omits or otherwise fails to advise Goals®, or any affiliated medical professional, of any pre-existing condition, or any other health related condition which, at the time of the procedure, prevents Goals® from proceeding with the surgery or treatment, then this shall be deemed as a cancellation by the Patient, in accordance with Subsection 5(e) below.
d. Other Cancellation(s). When Patient reserves its procedure date consistent with Section 4 herein, Goals® relies on the Patient to be present and does not book other willing and able patients for that same date and time. Goals® also begins to immediately plan and prepare for your procedure and the Patient Coordinators and medical staff expend an extensive amount of time and effort to ensure that the Patient is prepared for surgery. Additionally, Goals® orders special supplies, coordinates with surgical staff and anesthesiologists (if applicable) and prepares and sterilizes special medical equipment for the Patients’ surgery. Therefore, if Patient cancels for any reason other than those set forth in Sections 5(a) through 5(c), Patient understands that such cancellation shall be deemed as without reason and subject to the terms of Section 5(e) below.
e. It is very difficult for Goals® to accurately predict the actual damages that would stem from Patient’s cancellation of the Procedure on the date this Agreement is signed, therefore, if the Patient cancels their Procedure for any reason, other than for medical necessity, PATIENT WILL FORFEIT ANY AND ALL OF THE FEES THAT PATIENT HAS PAID TOWARD THE PROCEDURE AS OF THE DATE OF CANCELLATION, INCLUDING THE INITIAL FEE, ALL INTERIM AMOUNTS AND ALL AMOUNTS PAID TOWARD LABORATORY FEES/BLOODWORK, ACCESSORIES AND COMPRESSION GARMENTS. Patient agrees and understands that this forfeiture is not a punishment but serves to compensate Goals® for all the work that they have done in anticipation of the Procedure and for the lost income due to Patient’s breach of this agreement. Patient understands and agrees that, in the event of any cancelation due solely from the conduct of the Patient as set forth herein, that this Agreement and all facts shall be used as evidence of Patient’s understanding of their obligations herein and agreement to be bound by them and, in such event, any such litigation brought against Goals® or any of its doctors, staff, agents, employees or affiliates as a result shall be dismissed pursuant to the terms herein.
f. Notwithstanding anything to the contrary, any cancellations herein shall be made by the patient to Goals® and not to any other entities or financing companies. Similarly, Patient shall not request a charge back or refund from any financing agency. Should the Patient seek or request a refund from any financing company in violation of this agreement, it shall be deemed a material breach of this agreement. Further, Patient agrees and understands that a copy of this agreement shall be submitted to any financing company if there is a violation of this agreement and, as a result, Patient agrees that any request for a charge back shall be denied. Further, if the procedure is performed, and Patient thereafter seeks a chargeback, the Patient understands and agrees that it shall be liable to Goals® for any compensatory damages that Goals® suffers seeking to ensure payment and the Patient shall pay all of Goals®’ legal fees and costs of litigation incurred from being constrained to retain an attorney to enforce the terms herein in the event of a chargeback.
6. Touch Up and Revision Policy.
a. Liposuction and abdominoplasty are not weight reduction procedures. Patient understands that, to maintain their newly contoured body shape, they must commit to changing their habits, including eating and exercise habits, in order to avoid weight gain and/or loss. Furthermore, for optimal results, Patient must follow the explicit post-operative instructions provided to Patient in the Patient Information Booklet.
b. If Patient is not happy with the initial results, Goals® may agree, in its sole and exclusive discretion to revise or touch up Patient’s results at a reduced fee of $850.00 which covers anesthesia, operating room, and nursing fee, “before and after” photographs, and other costs, as long as the following conditions have been 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 remained the same since the Procedure Date (i.e. the Patient’s BMI has not deviated more than 2% since the Procedure Date).
iii. The Patient has not been pregnant or given birth since the Procedure Date.
iv. The Patient has not smoked or used any tobacco product(s) since the Procedure Date.
v. The Patient has followed all the post-operative instructions in the Patient Information Booklet. This means that Patient has:
A. Worn all required compression garments for the prescribed amount of time;
B. The Patient has received at least 10 Post-Operative massages from Goals® or an authorized and/or approved satellite or third-party location;
C. Attended all required post-operative follow up appointments and massages; and
D. Has followed all other Post-Operative Instructions in the Patient Information Booklet.
vi. The touch up is not a request for additional removal of fat/liposuction or fat injections in any area not treated with autologous fat transfer at the original Procedure.
vii. The touch up is for the problem area which was treated in the original procedure.
Revisions are not new procedures and are solely meant to correct minor issues that are the natural result of the procedures such as concave areas or small bulges.
7. Results and Complications – NO GUARANTEES. The practice of medicine and surgery, including cosmetic surgery, is not an exact science. Although good results are anticipated, there can be no guarantee or warranty, expressed or implied, by anyone, as to the actual results of the Procedure. Revisions and or other medical treatments or management of problems or complications may be required. These may result in additional charges for which you are responsible.
In the event that a Patient fails to pay for these additional charges, Patient will further be responsible for all collection costs, including, but not limited to reasonable attorney fees, court costs, interest (as permitted under the NY collection laws) and collection agency fees (if applicable).
8. Patient Responsibilities, Medical Clearance(s), and Pre- and Post-Operative Instructions. Patient acknowledges that they are aware that blood work and medical clearance from a licensed physician of Patient’s choice is required before the Procedure can be done. Blood work and Medical Clearance must be performed and results provided no more than thirty (30) days before the scheduled Procedure Date and shall be proved no less than fourteen (14) days before the scheduled Procedure Date. It is Patient’s responsibility to ensure that blood work and medical clearance is timely performed and submitted Goals® in this time frame. Patient acknowledges that he or she received a blood work and medical clearance packet to provide to the physician of their choice. Alternatively, Patient may complete medical clearance at Goals®. Goals® reserves the right to charge an additional fee for in-office medical clearance.
Patient acknowledges that he or she has received a Patient Information Booklet and that a member of the Goals® team has reviewed this information with the Patient at the initial consultation. Patient acknowledges that he or she has understood this information and has been given the opportunity to ask questions and voice his or her concerns. Furthermore, Patient understands that he or she may contact Goals® at any time with any further questions or concerns.
- The information contained in the Patient Information Booklet is as follows:
- Tumescent Liposuction Under Local Anesthesia: Expected Outcomes, Risks & Benefits
- Risk of Smoking When Getting Cosmetic Surgery
- Pre-Procedure Instructions: One to Two Weeks Prior to Surgery
- Pre-Procedure Instructions: Day of Surgery
- What to Expect of the Day of Your Procedure
- Post-Liposuction Instructions & Post-Fat Transfer Instructions
- List of Medications and Foods that Potentially Interact with Tumescent Anesthesia
Patient also acknowledges that, no less than twenty-four (24), and no greater than forty-eight (48) hours before the scheduled procedure, Patient must deliver to Goals® all accessories required for after the procedures. This includes, but is not limited to, Fajas, Boards, and Foams. Failure to provide these items to Goals® within this time frame will result in either the procedure being rescheduled or, alternatively, Goals® providing new items which shall be paid for by Patient prior to any surgery or procedure being performed.
a. SEVERABILITY. If any provision of this Agreement, or the enforcement thereof, is held by an arbitrator or a court of competent jurisdiction to be invalid, unenforceable or illegal, in whole or in part, in any respect, that holding shall not affect the validity and/or enforceability of any other provision of this Agreement.
b. SURVIVAL. The representations, warranties and covenants contained in this Agreement or in any other document delivered hereunder shall survive the execution of this Agreement.
c. ENTIRE AGREEMENT/AMENDMENTS. This Agreement represents the entire agreement, between and among the Parties, with respect to the subject matters referred to herein. There are no promises, inducements, representations, warranties, understandings, undertakings or agreements, oral or written, express or implied, by, between or among the Parties, except as specifically set forth herein, with respect to the subject matter of this Agreement.
This Agreement may not be altered, amended, canceled, revoked or otherwise modified except by written agreement subscribed by all Parties whose rights and obligations are affected by such amendment, cancellation, revocation or other modification.
d. HEADINGS AND SYNTAX. The headings set forth in this Agreement are for convenience and reference only and are not intended to modify, limit, enlarge, describe or affect in any way the content, scope or intent of this Agreement. All references made and pronouns used shall be construed in the singular or the plural and in such gender as common sense and circumstances indicate and require.
e. GOVERNING LAW. This Agreement and any other documents referred to herein shall be governed by, construed, and enforced in accordance with the laws of the State of Florida without regard to conflicts of laws principles.
f. FURTHER ASSURANCES. The Parties hereto agree to execute such other documents and to take such other action as may be reasonably necessary to further the purposes of this Agreement.
10. Lateness Policy. The Patient must arrive to the office on the Procedure Date at least one (1) hour prior to the scheduled time for the subject Procedure. The Patient will be charged a late fee of $250.00 for every fifteen (15) minutes that Patient is late as such lateness causes disruption in scheduling for the Patient and other patients as well as the surgeons. All late fees must be paid in full, or the procedure will be cancelled. Since this cancellation is a direct result of Patient’s own actions, failure to pay the late fees will be treated as a cancellation by the Patient, in accordance with Section 5(e) above.
11. State Specific Rules for Liposuction. The amount of fat that may be removed in a liposuction is based upon multiple factors including state regulations. Currently, for all procedures in Florida, no more than 4,000 cc of fat may be removed during a single procedure. Goals® will not exceed this amount of fat removal in a single procedure. Indeed, pursuant to the surgeon’s medical judgment, less than this amount may be removed to ensure Patient safety while still seeking to perform the results sought by the Patient. However, Goal’s and its doctors/surgeons view patient safety as paramount.
12. Loose/Excess Skin. Liposuction is the removal of subcutaneous fat and not skin. The skin over the areas subject to liposuction may be loose after a procedure and may, or may not, regain elasticity without additional intervention including surgical intervention. The Patient understands and acknowledges that additional procedures may be required to remove loose skin which is not part of the price of the liposuction procedure.”