Esthetician / Cosmetic Registration Form

Four Seasons Dermatology Cosmetic Financial Policy Thank you for choosing Four Seasons Dermatology. As part of this relationship, we wish to establish our expectations of your financial responsibility as outlined below. 1 - PAYMENT IS EXPECTED IN FULL. We accept cash, check, or credit card (Visa, MasterCard, Discover, and AMEX). 2 - COSMETIC SERVICES. Cosmetic procedures or consultations are not billable to insurers. 3 - RETURNED CHECKS will incur a $20.00 service charge. 4 - MISSED OR CANCELLED APPOINTMENTS. Esthetician customers that miss or cancel an appointment with less than 24-hour’s notice may be assessed a $50.00 charge.

Please note that if you are more than 10 minutes late for your appointment, your appointment may need to be rescheduled.