WELCOME, WE ARE GLAD YOU ARE HERE!
We want to assist you in obtaining the cosmetic and wellness results you’ve always wanted, whether you use our med spa facial or laser services as a client of Phaze Laser Med Spa, or are a patient for cosmetic surgery and wellness treatments by Dr Thaker.
You may fill out the attached forms prior to your first visit to ensure your treatment does not begin late nor that your time is cut short. Note that all pages must be signed, including our financial information page. No cross outs or extraneous commentary is permitted. We require this basic set of forms to be completed in their entirety before any visit may begin for any of our diverse services. Please print out and complete this PDF.
Our office works with you to streamline insurance processing (when available) and account handling for pain procedures and/or primary care.
We accept cash and major credit cards as forms of payment for all services.
For surgical procedures and large package services, we offer patient financing on a case by case basis, see below.
All sales final on all services. No guarantee of results has been implied or made. A $50 no show fee or service reinstatement fee is charged as applicable for failing to provide at least 24 hour notice of cancellations.
For medically necessary visits, both pain management and select primary care, we request you send in advance the front and back of applicable insurance cards and your state ID. Fax 667 218 3073 or email firstname.lastname@example.org.
We require a valid credit card on file for costs not covered by insurance. Best practice is to send us insurance card photos or all details in advance to verify coverage.
We accept: Medicare (traditional) Medicaid (traditional) Anthem/BCBS UHC Cigna Teachers Health Tricare Ambetter/Silver Summit and many other PPO and HMO plans
Other Terms and Conditions
ALL LASER HAIR REMOVAL AND LASER TATTOO REMOVAL PACKAGES:
Further, for safe, prompt and predictable results, and to respect scheduling of all clients, note the following policies: First session must be completed 30 days from purchase. Each session thereafter you must request and complete within 4-6wk. If you fail to complete a session as described, it is forfeit, whether you did not schedule, canceled, no show, or for any other reason. All of 6 sessions expire 6mo after your first session is due, all of 4 sessions expire 4mo after your first session, and so forth. An easy way to remember this is that you are due for a session at 4-6 week intervals, and lose that service if you do not schedule it and attend.
A $50 reinstatement charge is due to continue services. We may reinstate the forfeit session if of comparable value. If in our sole judgment you can not complete a package due to unforseen circumstances, then we subtract used sessions at full retail value of 200% of the discounted package value, from any refund if any.
For surgery or large package options, for your convenience, we also offer several financing options on a case by case basis. We can assist you in applying for financing through a variety of options. Our financing plans offer easy terms, 0% or low interest rates, and other flexible payment options to best fit any budget.
CareCredit is a company that provides patients with credit for their elective procedures, offering short-term, 0% interest payment plans and low-interest, extended payment plans.
LendingUSA helps you get easy and affordable financing – so you can buy more of the goods and services you want, when you want them.
No guarantee of results is made or implied. Individual results may vary. Some photos may contain models, not practice patients. All sales final. Other terms may apply, inquire.