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Golden Isles Center for Plastic Surgery

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BOTOX® Subscriptions

All Botox treatments must be 60 days apart. Up to four treatments allowed per year with your subscription.  Additional treatments or areas may be purchased at our regular pricing.

_______ (Initials)If you are receiving your first treatment on the same day as you are starting your subscription, there will be a deposit required of $ ______. This amount will be subtracted from the total subscription cost to determine your monthly charge.

These prices are already discounted and can not be combined with any other promotional offer.

________ (Initials) By signing up for subscribe and save you are agreeing to making a payment of $______ that will automatically be charged to your credit card on file on the _____ day of each month.

In the event your credit card information changes, cancels or expires our office will make the attempt to contact you to update the payment on file. If we are unable to update the credit card information your treatments will not resume, and we will make every attempt to collect the amount that has already been used as a part of your subscription plus the cancellation fee.

If there are insufficient funds or declined payments that incur a fee from the banking institution that fee will be transferred to your account and be your responsibility. This fee will need to be satisfied and a new form of payment will be needed on file before future treatment can be administered.

You may cancel your subscription at any time. However, if you cancel your subscription prior to one year you will be charged a cancellation fee of $100 plus the full price of any Botox treatments already received, minus all payments made. Subscriptions cancelled after one year will waive the $100 cancellation fee.

Cancellation is effective immediately upon emailing your cancellation request to Meghan at marketing@drdianebowen.com. An email confirmation will be sent back to you for your records.

In the event you are no longer able to use your subscription, but you have accrued a credit with Golden Isles Center for Plastic Surgery you will be able to use that credit towards any other services we offer in the practice. We do not offer refunds, partial refunds but will honor credits from any of the subscribe and safe memberships.

 

Print Name:______________________________________________  Date:______________________

Address: ____________________________________________________________________________

Phone: _________________________ Email:_______________________________________________

Witness:_________________________________________________

 

Subscribe and Save Terms of Service

Thank you for signing up for our subscribe and save program.

Filler Subscriptions

All Filler treatments must be at least 4 months apart. Up to two treatments allowed per year with your subscription.  Additional treatments or areas may be purchased at our regular pricing.

_______ (Initials)If you are receiving your first treatment on the same day as you are starting your subscription, there will be a deposit required of $ ______. This amount will be subtracted from the total subscription cost to determine your monthly charge.

These prices are already discounted and cannot be combined with any other promotional offer.

________ (Initials) By signing up for subscribe and save you are agreeing to making a payment of $______ that will automatically be charged to your credit card on file on the _____ day of each month.

In the event your credit card information changes, cancels or expires our office will make the attempt to contact you to update the payment on file. If we are unable to update the credit card information your treatments will not resume, and we will make every attempt to collect the amount that has already been used as a part of your subscription plus the cancellation fee.

If there are insufficient funds or declined payments that incur a fee from the banking institution that fee will be transferred to your account and be your responsibility. This fee will need to be satisfied and a new form of payment will be needed on file before future treatment can be administered.

You may cancel your subscription at any time. However, if you cancel your subscription prior to one year you will be charged a cancellation fee of $100 plus the full price of any filler treatments already received, minus all payments made. Subscriptions cancelled after one year will waive the $100 cancellation fee.

Cancellation is effective immediately upon emailing your cancellation request to Meghan at marketing@drdianebowen.com. An email confirmation will be sent back to you for your records.

In the event you are no longer able to use your subscription, but you have accrued a credit with Golden Isles Center for Plastic Surgery you will be able to use that credit towards any other services we offer in the practice. We do not offer refunds, partial refunds but will honor credits from any of the subscribe and safe memberships.

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