Cosmetic Procedure Financial Agreement Letter

Letter -1

I am writing to bring to your attention that after looking at your medical reports and studying your case in detail, I and my team have concluded that you can undergo a cosmetic procedure. However, there are a few things I would like to communicate to you beforehand so you may get yourself prepared for it.

Your normal medical cases, surgery, and other consultancies are usually covered under medical insurance but cosmetic procedures are not covered under any policy. Therefore you need to sign a cosmetic procedure financial agreement with us, undertaking that you will bear all the financial charges for this process. For your convenience, I am sharing the terms and conditions with you in this letter. Kindly read them all and let us know when you are ready to sign the agreement so we may start your treatment. The terms and conditions are as follows:

  • I Paul Smith undertake that I give my full consent for my cosmetic procedure of mine which will be done in three stages. The details of the procedure are as follows:

Stage 1: Treatment Recommend: [x]
Stage 2: Treatment Recommend: [x]
Stage 3: Treatment Recommend: [x]

  1. I realize and hereby acknowledge that Dr George Muriel will be carrying out this procedure. 
  2. I acknowledge that no medical insurance will be covering the expense of my cosmetic procedure and I will bear the finances on my own. 
  3. I undertake that I will be submitting 50 percent of the amount of the procedure one week before my treatment. 
  4. If by any means I am not available on the given date of the treatment, I will not be able to claim my refund.
  5. In case I have paid the complete amount of the procedure and could not make it for any reason, only 50 percent will be refunded. 
  6. If I need to reschedule the appointment, I will be informing the doctor 3 days before treatment. 
  7. If I want to terminate the agreement and cancel the booking for treatment, I must inform the doctor 4 days prior given schedule to claim a full refund. 

Kindly go through the clauses at least twice and give me a call of confirmation at my number [x]. If you have any further queries regarding your procedure and this financial agreement, please do not hesitate to visit me tomorrow at 4:00 pm in my clinic. I look forward to hearing from you very soon. Thank you for your attention. 

Cosmetic Procedure Financial Agreement Letter

Letter -2

I am writing regarding your case of cosmetic procedure. I am pleased to inform you that your case has been approved and can opt for a cosmetic procedure. However, you are bound to sign a financial agreement to complete this process. As you know that no medical insurance covers cosmetic procedures so you will be bearing all the expenses on your own. I have attached the list of possible expenses for your procedure with this letter. Kindly have a look at them and let us know if you are comfortable in bearing this much amount $ [x] approx.

Moreover, I am sharing the terms and conditions of the financial agreement that you need to sign one week before your treatment. The clauses are as follows:

  1. I Drake Paul acknowledges that no medical insurance will be covering the charges for my cosmetic procedure, and I will be bearing the expenses on my own. 
  2. The mode of payment can either be cheque, cash, online, bank transaction, Debit card etc.
  3. The payment will be made in two halves. The first instalment will be paid one week before treatment and the next one will be paid after the procedure. 
  4. To claim a full refund, the patient needs to cancel the appointment 3 days prior to treatment. 

Kindly read all the clauses and let me know when you can sign the agreement. In case you have further queries you may reach me at my number [x] or visit me tomorrow at 3:00 pm in my clinic. I look forward to hearing from you soon. Thank you. 

Warm Regards, 

Cosmetic Procedure Financial Agreement Letter

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