The Female Pelvic Health Center & MedSpa

Financial Policy for Cash/MedSpa Procedures

This Financial Policy outlines our office policies for cash‐based and MedSpa services, including cosmetic, wellness, and elective procedures. Please review and sign to indicate your understanding and agreement.

1. Scheduling & Payment

• All MedSpa or elective procedures require full payment at the time of scheduling to secure your appointment.
• We accept cash, major credit cards, and approved financing options.
• Appointments are not considered confirmed until payment is received.

2. Cancellation, Rescheduling & Rebooking Policy

• We require a minimum of 48 hours’ notice to cancel or reschedule your appointment without penalty.
• Cancellations or rescheduling with less than 48 hours’ notice will result in a forfeiture of 50% of the procedure fee.
• No-shows (failure to appear without notice) will result in forfeiture of 100% of the procedure fee. 
• Rescheduling/credit validity:
  • If you cancel or reschedule with proper notice, your prepaid amount may be applied toward a future appointment.
  • The prepaid amount must be applied to a new appointment within 6 months of the original scheduled date. After 6 months, any unused credit will be forfeited.
  • Only one reschedule is permitted per prepaid procedure without penalty; additional changes may incur a fee or loss of prepaid amount at our discretion.

3. Refund Policy

• Payments for MedSpa and elective procedures are nonrefundable once services are rendered.
• Payments made in advance are refundable only if:
  • Cancellation occurs more than 48 hours prior to your scheduled appointment, or
  • The procedure is deemed medically inappropriate by our provider and has not yet been performed.
• Any approved refund will be returned by the same method of payment within 10 business days.
• Packages or pre-paid services are non-transferable and must be used within the timeframes stated at purchase.
• Product sales (skincare, supplements, etc.) are final unless defective.

4. Late Arrival Policy

• Arriving more than 15 minutes late may shorten your treatment time or require rescheduling at the provider’s discretion.
• Standard cancellation fees may apply.

5. Acknowledgment & Consent

By signing below, I acknowledge that I have read and understand the Financial Policy and agree to comply with its terms. I understand that payments for MedSpa and elective procedures are due at the time of booking and that refunds are limited to the terms outlined above.

Patient Name: ___________________________

Signature: ___________________________

Date: ___________________________