Surgical and Anesthetic Deposits

The following information is provided to you as a courtesy to ensure understanding of the deposits collected for surgeries, drop-offs, hospitalization, and/or complex procedures and diagnostics.

For scheduled procedures:

• A deposit of no less than $150 is collected to secure the reservation for planned or scheduled surgeries, anesthetic procedures, and drop-offs for extended diagnostics.
• The deposit is considered non-refundable if the procedure is not performed due to any of the following reasons:
  • The patient fails to arrive on time as scheduled for drop- off
    • Drop-off time is 8 am the morning of the procedure.
    • Patients arriving more than 30 minutes late will forfeit their deposit and will need to reschedule the procedure.
  • The procedure is cancelled without rescheduling.
  • The procedure is not performed, but other services are rendered that day due to unexpected medical complications that necessitate postponing the procedure. In this case, the deposit will be applied to the services provided and the owner is responsible for any remaining balance.
• The deposit will be applied to the total cost for services rendered the day of the procedure.
• If the procedure needs to be rescheduled, as a one-time courtesy, the deposit may be applied to a new date according to the following:
  • The newly scheduled date is for the same procedure.
  • The newly scheduled date must be within two weeks of the original date.
  • Reschedule requests must be made and confirmed before 5pm the day prior to the procedure. Voicemail and text messages submitted after closing the day before will be subject to deposit forfeiture.

For unplanned/unscheduled procedures:

• A deposit of no less than $150 is collected for unplanned/unscheduled anesthetic procedures or extended diagnostics and treatments that are deemed necessary during an office visit that necessitate leaving the patient in our care for several hours.
• The deposit will be applied to the total cost for services rendered that day.

Please sign to acknowledge understanding and acceptance of the Surgical and Anesthetic Deposit.