Edward M. Zimmerman, MD, PC, DBA Aesthetic Revolution Las Vegas will accept payment by cash, money order, or credit card. We do not accept personal or bank checks. You must be paid and full at the end of each appointment.
Appointments with Dr. Zimmerman and Dr. Lee continue to require a $100.00 deposit. The $100.00 deposit is applied towards any treatment or product sold in the office, or your next appointment deposit. In the case of a no show, reschedule with less than a 48 hour notice, late cancellation, or late arrival, the $100.00 deposit will not be applied/refunded.
Appointments with practitioners other than Dr. Zimmerman and Dr. Lee are scheduled with a $50.00 deposit. In the case of a no show, reschedule with less than a 24 hour notice, late cancellation, or late arrival, a $50.00 fee will be charged and collected prior to future appointments being scheduled.
A non-refundable 20% deposit is due at the time of booking a surgery date. Surgery must be paid in full two (2) weeks prior to the surgery date. A portion of monies collected may be refunded if surgery is cancelled one (1) week prior and we are able to fill the allowed time slot; otherwise, no refund will be issued.
Medical Records: Records released to the patient will be charged $0.60 per page copied. Payment in full must be received before your records will be released. Please allow ten (10) working days for your records to be copied.
Lab Charges: Lab charges are NOT included in your office visit. Charges for any lab work done in the office will be billed separately by a local lab. You will be getting a bill in the mail from the lab. We forward all billing information to the lab for insurance processing or private billing. If you have any questions, please contact the lab that sent you the bill.
Radiology: Radiology charges are NOT included in your office visit. The office will obtain authorization for any radiology procedures that Dr. Zimmerman or Dr. Lee feels are necessary to your health care. It is ultimately your responsibility to confirm if the facility and procedure is covered by your insurance.
If you have any questions or concerns, please feel free to ask a staff member for clarification.
ACKNOWLEDGEMENT- RECEIPT OF NOTICE OF PRIVACY PRACTICES
I acknowledge that I have received a copy of Edward M. Zimmerman, MD, PC, DBA Aesthetic Revolution Las Vegas’s “Notice of Privacy Practices.” This notice describes how Edward M. Zimmerman MD, PC, DBA Aesthetic Revolution Las Vegas may use and disclose my protected health information, certain restrictions on the use and disclosure of my healthcare information, and rights I may have regarding my protected health information.
ACKNOWLEDGEMENT- RECEIPT OF PATIENT RIGHTS & RESPONSIBILITIES
I acknowledge that I have received a copy of Edward M. Zimmerman, MD, PC, Aesthetic Revolution Las Vegas’s “Patient Rights & Responsibilities.” This notice describes my rights and responsibilities as a patient of this office.
ACKNOWLEDGEMENT AND CONSENT FOR NEEDLESTICK INCIDENT
I understand that sometimes in the course of treatment there can be an accident, whereby a needle used on me for treatment may somehow stick my caregiver. In the event this would occur, I give my full consent for Dr. Zimmerman and his staff to obtain the necessary blood samples for infectious disease testing recommended by OSHA standards. There will be no cost to me for this testing and I will provided copies of the results for my medical record.