Cosmetic Procedure Agreement for Word

A cosmetic procedure agreement is a written document stating all the conditions pertaining to undergoing cosmetic procedures. These procedures can be surgical or non-surgical and are mainly performed to enhance the natural beauty of an individual.

These procedures are more common among women than men and are performed with utmost care because a slight change can damage the complete structure. Cosmetic procedures mostly include changes in face structure such as lip fillers, Botox, reshaping the nose, highlighting cheekbones, and reshaping jawline to provide great facial features. These agreements are legal and official documents that are used to protect the rights of patients as well as doctors or staff performing the procedures.

Template of cosmetic procedure agreement is provided below,

Agreement Template

This agreement is prepared on the date [DATE] between [X] and [Y],

Hospital

Name: XYZ Institute
Address: 38 Hall Road, New York, USA.
Contact: 284 245-7292

Patient

Name: Jessica Pearson
Address: 23 Moon Street, New York, USA.
Contact: 345 245-8393

Terms and conditions of the cosmetic procedure agreement are mentioned below,

Part -1

  1. This agreement shall commence from date (__/__/__) and shall be taken very seriously.
  2. Procedure will be performed on date (__/__/__) at 0700 hours.
  3. Procedure will last for 3 hours under the supervision of experienced and qualified medical staff.
  4. In case of any complication during procedure, time duration may increase, and family will be notified about the complication.
  5. 75% of hospital dues will be cleared before the procedure is started to make sure that it is performed.
  6. 25% dues will be cleared after the procedure has ended and patient is not under the knife anymore.
  7. Results of cosmetic procedure will not affect the dues or their clearance.
  8. Immediate family, as notified by the patient, will be responsible for clearing all hospital bills.
  9. This agreement will only cover the cost of procedure, all other medical care, medicines, and food bills will be cleared at the moment.
  10. In case of prolonged procedure than anticipated, charges of the procedure might change.

Part -2

  1. Family will be responsible for clearing extra bills as well.
  2. Results of cosmetic procedure are not always successful therefore institute will not be held responsible.
  3. Patient will be required to stay at the hospital for a couple of days.
  4. Results of cosmetic procedures are evident after a few days; therefore, patients should keep calm.
  5. Results of cosmetic procedures require proper care after the task is done therefore post-op follow up is responsibility of the patient.
  6. Mostly, more than one cosmetic procedure brings out the desired results therefore it will be the choice of patient to go further or stop at one.
  7. This agreement is prepared in the presence of legal counsels of both parties to make sure their rights are intact.
  8. Two credible witnesses provided by both parties will also sign this agreement to make sure that process runs smoothly.

Hospital Administration

_____________________

         Signature

Date: __/__/__

Patient: Jessica Pearson

_____________________

       Signature

Date: __/__/__

Witness #1: Eric Dane

__________________

    Signature

Cosmetic Procedure Agreement for Word

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