FINANCIAL POLICY & PAYMENT TERMS

PLEASE READ AND INITIAL EACH SECTION. THIS DOCUMENT IS A LEGALLY BINDING AGREEMENT.

📌 IMPORTANT NOTICE – NON-NEGOTIABLE TERMS

  • All deposits are strictly non-refundable, regardless of the timing of cancellation—even if canceled within the hour of booking.
  • No cancellations or refunds are allowed for out-of-town treatments (e.g., NYC, Miami) due to travel costs, staffing, and high demand.
  • All credit card convenience fees are non-refundable.
  • Failure to complete required preoperative clearances at least 14 days in advance will result in forfeiture of all monies paid and surgery cancellation.
  • Consultation fees are valid only for use with the specific provider the consultation was scheduled and paid for. For example, a consultation booked with Dr. Jason Emer is valid only toward treatment with Dr. Emer. Likewise, a consultation booked with another provider (e.g., Brittany in NY) is only valid toward treatment with that provider. Consultation fees must be used within 90 days and may not be applied to any other provider, service, or product.

PREOPERATIVE CLEARANCES

  • All surgical patients must provide the following clearances no later than 14 calendar days prior to surgery: 
    • Medical History and Physical Examination
    • Cardiology clearance with a fully written Letter of Clearance from a board-certified cardiologist
    • Bloodwork (CBC, CMP, Coag Panel), EKG, and Chest X-Ray
    • Mammogram or Ultrasound report (breast cases only, or if previously abnormal) 
  • Preoperative clearances are valid for 30 days from the date they are issued.
  • Failure to complete and submit all required clearances at least 14 calendar days prior to surgery will result in automatic cancellation of the procedure and complete forfeiture of all monies paid. No exceptions will be made.

GENERAL PAYMENT TERMS

  • Quote Validity: Pricing is valid for 90 days from the date of the quote. The consultation fee is valid during this period only for use toward treatment with Dr. Jason Emer. It cannot be applied toward products or services with other providers. Deposits and consultation fees may not be transferred to different treatments or services not originally consulted for.
  • Payment Deadlines:
    • West Hollywood clinic: Full payment is due 14 days (2 weeks) prior to scheduled treatment. Any payments made prior to this deadline are considered deposits and are strictly non-refundable.
    • Out-of-town treatments (e.g., NYC, Miami): Full payment is due 20 business days (4 weeks) prior to treatment date. This includes deposit + full treatment payment. Due to travel planning, overhead, limited scheduling availability, and high demand, no cancellations or refunds are allowed for out-of-town treatments once booked.
    • Surgeries: Payment in full is due 20 business days prior to the scheduled procedure. Failure to pay in full by the required deadline will result in cancellation of the procedure.
  • All credit card convenience fees are non-refundable under any circumstance.

RESERVATIONS & DEPOSITS

  • All reservations require a 20% non-refundable deposit to secure your date.
  • Deposits apply to the total balance and cannot be transferred to other services or individuals.
  • All deposits are non-refundable under all circumstances, regardless of when the appointment is scheduled or how soon after booking a cancellation is requested—even if canceled within the same day or hour. Once a deposit is made, it is considered a commitment to the procedure and is not eligible for refund or transfer under any circumstance.

CANCELLATIONS & REFUNDS

  • Cancellations made more than 20 business days (4 weeks) before a scheduled surgery or treatment: Only the 20% deposit is non-refundable; all other payments will be refunded.
  • Cancellations made within 20 business days (4 weeks) of the scheduled procedure/treatment: All payments are non-refundable.
  • All skincare, aftercare products, aftercare services (including IVs, lymphatic massage, hyperbaric oxygen, HUGO, etc.) are FINAL SALE and non-refundable—even if the service is not performed. These services are scheduled and prepaid with providers and are non-transferable.
  • If you do not show up, or decide not to undergo the treatment at your scheduled time, the full cost of the service will be forfeited. The treatment will not be rescheduled or applied to another service or date.
  • All credit card convenience fees are non-refundable. No returns or exchanges will be accepted, regardless of product use.

POSTPONEMENTS & RESCHEDULING

  • With more than 20 business days’ notice: The 20% deposit is non-refundable and will not be applied to any future procedures or treatments under any circumstances.
  • With less than 20 business days’ notice: All payments are forfeited.

NON-SURGICAL TREATMENT POLICIES

  • No-shows or late cancellations will result in forfeiture of 100% of the treatment payment. The appointment will not be rescheduled and the funds cannot be transferred to another service.
  • If a treatment appointment was not prepaid, the full quoted treatment amount will be charged to the card on file in the event of a no-show.
  • All payments and deposits are non-refundable.

CONSULTATION FEE POLICY

  • All consultation fees are non-refundable under all circumstances.
  • If a patient arrives more than 15 minutes late to a scheduled consultation or treatment, the appointment will be canceled, no services will be performed, and all monies paid will be forfeited. Patients must rebook at full price. 
    • Paid consultations with Dr. Emer – forfeited and must be repaid in full to reschedule.
    • Paid consultations with a coordinator – forfeited and must be repaid in full to reschedule.
    • Free consultations – a $150 no-show fee will be charged to the credit card on file. 
  • Consultation fees serve as a credit only toward treatment with the specific provider the consultation was booked and paid for—e.g., a consultation with Dr. Jason Emer may only be applied toward treatment performed by Dr. Emer, and a consultation with another licensed provider (such as Brittany in NY) may only be applied toward treatment with that same provider. The credit must be used within 90 days and cannot be applied to products or services from other providers, even within the same practice. After 90 days, the consultation fee is forfeited.

CHARGEBACK POLICY (ANTI-FRAUD MEASURES)

  • Any chargeback filed against JASON J EMER MD PC will be treated as fraudulent activity.
  • All chargebacks will be challenged and prosecuted to the fullest extent permitted by law.
  • Filing a chargeback will immediately and permanently terminate the physician-patient relationship.
  • This action constitutes a breach of mutual trust and will be considered a willful act of bad faith, disrespect, and unprofessionalism.
  • We reserve the right to pursue civil and criminal remedies for chargeback fraud, regardless of the amount in dispute.
  • This includes, but is not limited to, charges related to overages in surgical and anesthesia time. Patients agree that such overage fees are legitimate medical costs incurred from third-party provider billing and are not eligible for chargeback or dispute. By signing this agreement, the patient waives any right to challenge these charges with their payment provider or credit card company.
  • In the event of a chargeback, the patient agrees to be responsible for all associated legal fees, attorney costs, and court-related expenses incurred by JASON J EMER MD PC in connection with recovering the disputed amount.

OVERAGES

  • Procedure room, surgical time, and anesthesia fees are based on estimates and are subject to final billing from the outside surgical and anesthesia providers (not related to the JASON EMER MD PC business entity).
  • If your procedure or anesthesia time exceeds the originally estimated duration, you authorize JASON J EMER MD PC to charge your credit card on file for the additional time based on the final invoice submitted by the surgical and anesthesia team.
  • These charges are mandatory, not subject to dispute, and are considered part of the agreed services outlined in your surgical consent and financial policy.
  • By signing this agreement, you waive your right to dispute or initiate chargebacks on these overage charges, as they reflect real-time, third-party provider billing for time utilized. 

COLLECTIONS

  • If payment obligations are not fulfilled, your account may be sent to a third-party collection agency.
  • You are responsible for all collection-related costs, including but not limited to a 35% collection agency fee and any legal or attorney fees incurred.
  • You authorize the clinic and its agents to contact you via call, text, email, or automated means, including your wireless number, and share your data for collection purposes. 

PAYMENT METHODS

We accept: Cash, Wire Transfer, Cashier’s Check, Credit Card, CareCredit, PatientFi, Alphaeon, Zelle, and Alle.

  • Note: A 3.99% processing fee applies to all credit card payments.

ACKNOWLEDGMENT & SIGNATURE

đź“Ś MANDATORY LEGAL CONSENT


I UNDERSTAND THAT THIS AGREEMENT WAIVES CERTAIN RIGHTS TO REFUND, DISPUTE, OR REASSIGN PAYMENTS AND I SIGN KNOWINGLY AND VOLUNTARILY.

 

  • By signing below, I acknowledge and agree to the following:
  • I have read, understood, and agree to the terms outlined in this Financial Policy.
  • I specifically agree to the overage and chargeback terms, including the waiving of rights to dispute overage-related charges and the responsibility for any legal fees incurred in chargeback recovery.
  • I understand that this policy is legally binding and enforceable.
  • I understand this document may be signed electronically and shall carry the same force as a physical signature under the U.S. E-SIGN Act.
  • I agree that any disputes arising from this agreement shall be resolved through binding arbitration in accordance with California law. This agreement applies to services rendered at all JASON EMER MD PC locations, including but not limited to West Hollywood, New York, and Miami.
  • I have had the opportunity to ask questions and was given a copy upon request.