Evolution MD Advanced Plastic Surgery is committed to providing the best possible patient experience. Our multidisciplinary support team evaluates each patient prior to their procedure and provides follow-up treatment and education afterwards, helping to foster best possible patient experience. The effective utilization of a multidisciplinary support team requires considerable administrative efforts and expense. As such, Evolution MD has implemented the following policies regarding patient financial responsibility. A 3% administration service fee will be assessed on all Credit and Debit Card payments. A 10% administration service fee will be assessed on all 3rd. party financial company payments. Your NON-REFUNDABLE surgery deposit of $500 or full payment can be made either with debit or credit card, cash, Zelle, Cash app, PayPal, wire transfer or a third-party financial company. Your surgery deposit of $500 will be applied as follows: $250 towards your surgical procedure and $250 towards your post op package if any. Upon the completion of any pre-op services identified below, an additional $1,000.00 of your charges shall also be NON-REFUNDABLE:

• Doctor Consultation
• Lab-Work
• Pre-Op
• EKG

If you decide to cancel your upcoming procedure, the total amount you have paid through the date of cancellation shall be NON-REFUNDABLE and will be available as a credit towards future service or product available from Evolution MD. It is important to understand that in the rare situation where a scheduled procedure cannot be completed as planned, due to factors beyond the providers control, including, but not limited to unforeseen unavailability of the facility, no refund will be issued. Your procedure will attempt to be rescheduled as soon as possible. In the rare situation that the doctor that was selected for your procedure is no longer t available for your surgery, you agree to accept another doctor provided by Evolution MD. You understand and acknowledge s that Evolution MD is not responsible for any airline tickets, hotel stays, and car rental or any additional expenses incurred because of any cancellations, no matter the cause. If an unknown medical condition is discovered during the pre-Operative process, it must be addressed before the procedure can proceed. It is the responsibility of the patient to address any issues that are preventing their procedure from going forward. Once the issues have been addressed to the satisfaction of Evolution MD, then the patient may start the process to continue with their procedure. The Patient acknowledges that there may be certain conditions that once identified may prevent them from having their desired procedure. If Evolution MD must cancel your surgery on the same day due to pregnancy or as a result of the patient’s failure to abide by the safety policies and protocols Evolution MD has in place for the safety of the patient, including but not limited to those dealing with the use of illegal substances found in patient’s systems preoperatively, the patient agrees, acknowledges and understands that they will be charged a $1,000.00 cancellation fee. The fees set forth in this agreement are guaranteed from the date of this agreement up to 365 days thereafter. In the event that the surgical procedure contemplated herein is schedule beyond this time period, additional charges may be applicable