Payment Policy

New Image Laser Skin Center is a free-standing medical facility providing aesthetic treatments in the form of cosmetic laser, BBL, Botox, facial fillers, HydraFacials, acne treatment, body sculpting, as well as pharmaceutical grade skincare product sales.

New Image Laser Skin Center is a cash based entity. All treatments and products provided at New Image Laser Skin Center are considered cosmetic and/or elective and require payment in advance in the form of cash, check, credit/debit card. When payment is made for desired treatment, an appointment can be established for that treatment.

Consultations and follow-up exams with staff are intended to clarify treatment modalities available, answer questions, and determine treatment choices mutually agreed upon by your provider and the client/patient.

Once payment is made for the agreed upon services and/or skincare products, independent of or as a result of a provider consultation, this is a no refund policy. If treatments must be suspended for any reason a credit will remain on the client account for a period or up to 6 months.

Cancellation Policy

In an attempt to have mutually satisfying appointments available for all our New Image clients, we require notification of no less than 24 hours in advance of an appointment in order to cancel or reschedule. A courtesy confirmation call will be made two business days before a scheduled appointment. There will be a $40 fee for any 30 minute appointments and a $80 fee for any appointments 60 minutes or more cancelled or changed less than 24 hours before the appointment.

HIPPA & Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment or health care operations (TPO) and for other purposes that are permitted or required by law.  It also describes your rights to access and control your protected health information.  “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.

Uses and Disclosures of Protected Health Information

Your protected health information may be used and disclosed by your physician, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the operations of the physician’s practice, and any other use required by law.

Treatment:  We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services.  This includes the coordination or management of your health care with a third party.  For example, we would disclose your protected health information, as necessary, to a home health agency that provides care to you.  For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.

Payment:  Your protected health information will be used, as needed, to obtain payment for your health care services.  For example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission.

Healthcare Operation:  We may use or disclose, as needed, your protected health information in order to support the business activities of your physician’s practice.  These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, and conducting or arranging for other business activities.  For example, we may disclose your protected health information to medical school students that see patients at our office.  In addition, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physician.  We may also call you by name in the waiting room when your physician is ready to see you.  We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment.

We may use or disclose your protected health information in the following situations without your authorization.  These situations includes: as Required By Law, Public Health issues as required by law, Communicable Diseases:  Health Oversight: Abuse or Neglect: Food and Drug Administration requirements: Legal Proceedings: Law Enforcement: Coroners, Funeral Directors, and Organ Donation: Research: Criminal Activity: Military Activity And National Security: Workers Compensation: Inmates: Required Used and Disclosures: Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500.

Other Permitted and Required Uses and Disclosures Will Be Made Only With Your Consent, Authorization or Opportunity to Object unless required by law.

You may revoke this authorization, at any time, in writing, except to the extent that your physician or the physician’s practice has taken action in reliance on the use or disclosure indicated in the authorization.

Your Rights

Following is a statement of your rights with respect to your protected health information.

You have the right to inspect and copy your protected health information.

Under federal law, however, you may not inspect or copy the following records: psychotherapy notes: information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information.

You have the right to request a restriction of your protected health information.

This means you may ask us not to use or disclose any part of your protected health information for the purpose of treatment, payment or healthcare operations.  You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purpose as described in this Notice of Privacy Practices.  Your request must state the specific restriction requested and to whom you want the restriction to apply.

Your physician is not required to agree to a restriction that you may request.  If physician believes it is in your best interest to permit use and disclose of your protected health information, our protected health information will not be restricted.  You then have the right to use another Healthcare Professional.

You have the right to request to receive confidential communications from us by alternative means or at an alternative location.  You have the right to obtain a paper copy of this notice from us.  Upon request, even if you have agreed to accept this notice alternatively i.e. electronically.

You may have the right to have your physician amend your protected health information.  If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.

You may have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information.

We reserve the right to change the terms of this notice and will inform you by mail of any changes.  You then have the right to object or withdraw as provided in this notice.

SMS Terms & Conditions

The information (phone numbers) obtained as part of the SMS consent process will not be shared with third parties for marketing purposes.

If you have consented to receive text messages from New Image Laser Skin Center, you may receive messages related to the following:

• Appointment reminders

• Follow-up messages

Example: “Hello, this is a friendly reminder of your upcoming appointment with Dr. Madsen at New Image Laser Skin Center on (date) at (time). You can reply STOP to opt out of SMS messaging from New image Laser Skin Center at any time.”

Message Frequency: Message frequency may vary depending on the type of communication. For example, you may receive up to 10 messages per week, related to your appointments/responses to your inquiries from New Image Laser Skin Center.

Potential Fees for SMS Messaging: Please note that standard message and data rates may apply, depending on your carrier’s pricing plan. These fees may vary if the message is sent domestically or internationally.

Opt-In Method: You may opt-in to receive SMS messages from New Image Laser Skin Center in the following ways:

1. Verbally, during a conversation

2. On the Client Medical History form

3. Sending a request via the New Image Contact form on our website at https://www.newimagelsc.com/contact

Opt-Out Method: You can opt out of receiving SMS messages at any time. To do so, simply reply “STOP” to any SMS message you receive. You can contact us directly to request removal from our messaging list.

Help: If you are experiencing any issues, you can reply with the keyword HELP. Or, you can get help directly from us at https://www.newimagelsc.com/contact

You may also decline to check the SMS message consent on our forms.

Standard Messaging Disclosures:

• Message and date rates may apply

• You can opt out at any time by texting “STOP”

• For assistance, text “HELP” or visit our HIPPA NOTICE OF PRIVACY PRACTICES WITH TERMS AND CONDITIONS AT https://www.newimagelsc.com/policies

• Message frequency may vary

Complaints

You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us.  You may file a complaint with us by notifying our privacy contact of your complaint. We will not retaliate against you for filing a complaint.

This notice was published and becomes effective on/or before Jan 1, 2022.

We are required by law to maintain the privacy of, and provide individuals with, this notice of our legal duties and privacy practices with respect to protected health information and contact information.