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Your appointment time is reserved just for you. A late cancellation or missed visit leaves a hole in the Health Provider’s day that could have been filled by another patient. As such, we require 24 hours notice for any cancellations or changes to your appointment. Patients who provide less than 24 hours notice, or miss their appointment, will be charged a cancellation fee to the card on file in the amount of $50.00 USD
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
WHO WILL FOLLOW THIS NOTICE? This notice describes the practices of Mana Wellness & Aesthetics, LLC and the practices that will be followed by all Mana Wellness & Aesthetics, LLC workforce members who handle your medical information. This notice is based on requirements by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) in good faith but is not a recognition by Mana Wellness & Aesthetics, LLC of its liability thereunder as this is a non-insurance billing practice.
OUR PLEDGE REGARDING YOUR PROTECTED HEALTH INFORMATION Mana Wellness & Aesthetics, LLC understands that medical information about you and your health is personal. We are committed to protecting medical information about you. We maintain our records and conduct our treatment environment with a goal of providing a robust level of protection for your medical information, while still providing you with a high level of medical care. This notice applies to all of the records of your medical care which are received or created by [Practice Name]. Your other medical treatment providers (e.g. doctors, nurses, hospitals, home health agencies, etc.) may have different policies or notices regarding the use and disclosure of your medical information. This notice will tell you about the ways in which Mana Wellness & Aesthetics, LLC may use and disclose medical information about you. Your medical information, also referred to as “protected health information” is that information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health information and related health care services. In this notice, we also describe your rights and certain obligations Mana Wellness & Aesthetics, LLC has regarding the use and disclosure of your protected health information.
We are required to: 1. Make sure that medical and other information that identifies you (protected health information) is kept private. 2. Give this notice of our legal duties and privacy practices with respect to protected health information about you. 3. Follow the terms of the notice that is currently in effect. 4. To request your records, please send Mana Wellness & Aesthetics, LLC a written request for your medical records.
USES AND DISCLOSURES FOR TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS By becoming a patient at Mana Wellness & Aesthetics, LLC, you are giving consent for Mana Wellness & Aesthetics, LLC to use your protected health information for certain activities, including treatment, payment and other health care operations. We may use and disclose protected health information about you so that Mana Wellness & Aesthetics, LLC and its medical professionals can treat you. For example, we may use your past medical information in order to diagnose your present condition or we may provide information regarding your medical condition to another doctor to whom we refer you for additional care. We may also use and disclose protected health information about you so that we may be paid for the medical treatment we provide you. We may also use and disclose protected health information about you for Mana Wellness & Aesthetics, LLC health care operations, in other words, those other tasks that we need to perform to make sure that you are provided a high quality of medical care. For example, we may use your protected health information to evaluate how we can better meet your needs. We may also share your protected health information with third parties in connection with services that we provide or if required by law or upon regulatory request. [Other uses and disclosures of your protected health information] The following uses of your protected health information may be made without any additional authorization from you. (Not every use or disclosure is listed, but be assured that all uses and disclosures made by Mana Wellness & Aesthetics, LLC are only those which are permitted under the law). Uses and disclosures for appointment reminders. Furthermore, any pictures, stories, letters, biographies, correspondence, or thank you notes sent to us become the exclusive property of Mana Wellness & Aesthetics, LLC. We reserve the right to use non-identifying information about our clients (those who receive services or goods from or through us)
If I have any questions about this notice or would like to file a complaint, I may contact Office Manager/Practice Owner by calling (201)824-2200 or emailing info@manawellnessandaestheticsgroup.com
At Mana Wellness and Aesthetics before and after photographs of all treatment areas are required and will be securely uploaded into the patient’s medical chart. This is a standard practice implemented for clinical documentation, treatment planning, and progress tracking.
Prior to any procedure, a designated team member will take high-quality photographs of the treatment area(s). Following the procedure, a second set of photographs may be taken to document the immediate results.
Patient confidentiality is our highest priority. All images are securely stored in the patient’s medical chart and primarily used for clinical documentation and treatment evaluation.
Photographs will never be shared externally, including for marketing or social media purposes, unless all identifying features are removed and the patient’s identity is fully concealed.
We thank you for your cooperation in following this policy, which ensures we maintain the highest standards of care, safety, and documentation at Mana Wellness and Aesthetics.
At Mana Wellness and Aesthetics, we are committed to providing transparent and high-quality care in a comfortable and supportive environment. To ensure clarity regarding financial matters, we have established the following policy for all patients:
We accept the following payment methods:
We do not accept insurance, checks, or other forms of third-party reimbursement. All services provided are elective and considered out-of-pocket expenses.
Payment is due in full at the time of service unless a payment plan has been arranged and approved in advance.
If a payment plan is selected, patients are responsible for ensuring that all scheduled payments are made on time according to the agreed-upon terms.
A late fee may be applied to any missed payment as outlined in your payment agreement.
Failure to meet financial obligations may result in the suspension of future treatments until the balance is resolved.
Due to the nature of wellness and aesthetic services, all sales are final. We do not offer refunds for services rendered or for unused portions of treatment packages or prepaid services. Exceptions may be considered under specific circumstances and must be reviewed and approved by management.
We encourage open communication. If you have any questions regarding your balance, payment options, or financial agreement, please speak with a member of our front desk or administrative team prior to your appointment.
At Mana Wellness and Aesthetics, we are dedicated to providing high-quality aesthetic procedures and wellness treatments tailored to each client’s individual goals. While our team is committed to delivering exceptional care and results, it is important to understand that aesthetic/wellness outcomes can vary from person to person.
Many factors—such as individual body chemistry, healing response, lifestyle, and other external influences—can impact the final results of any procedure/treatment. Although we utilize advanced techniques and professional expertise, we cannot guarantee specific or uniform outcomes for all clients.
We recognize how important your aesthetic/wellness goals are, and we work diligently to guide you toward the best possible outcome. During the consultation process, our providers offer detailed information about each procedure, including expected results, potential risks, and any limitations, to help you make a fully informed decision.
Due to the personalized nature of aesthetic treatments and the variability of individual responses, Mana Wellness and Aesthetics has a strict no-refund policy for all procedures/treatments provided. This includes both single treatments, packages and memberships.
We encourage all clients to communicate openly with our team, ask questions, and set realistic expectations. While we stand behind the quality of our services and the expertise of our providers, it is essential to acknowledge that results may vary and are not guaranteed.
Thank you for trusting Mana Wellness and Aesthetics with your care. We remain committed to your safety, satisfaction, and overall wellness throughout your journey with us.
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We kindly require a nonrefundable $20 deposit to secure your appointment. This deposit will be applied toward the cost of your services.
